Full text of "The 1960 Annual Report of the Children's Hospital Medical Center"

The Children's Hospital Medical Center

The 196

Report

THE CHILDREN'S HOSPITAL MEDICAL CENTER, BOSTON

comprising:

The Children's Hospital

Infants' Hospital

The House of the Good Samaritan

Sarah Fuller Foundation for Little Deaf Children

Sharon Sanatorium

The Hospital and Convalescent Home for Children

Charitable Surgical Appliance Shop

and affiliates:

Children's Cancer Research Foundation, Inc.

Judge Baker Guidance Center

Children's Mission to Children

of the Children's Hospital Medical Center

THE CHILDREN'S HOSPITAL MEDICAL CENTER

OFFICERS, BOARD OF TRUSTEES

William W. Wolbach

PRESIDENT

G. Peabody Gardner

VICE PRESIDENT

Alexander Wheeler
VICE PRESIDENT

F. Murray Forbes, Jr.

TREASURER

Arnold W. Hunnewell

SECRETARY AND ASSISTANT TREASURER

Mrs. David Wilder

CHAIRMAN, WOMEN'S COMMITTEE

Nelson S. Bartlett, Jr.
ASSISTANT TREASURER

Director

Joseph P. Greer

Chiefs of Staff

Sidney Farber, M.D.

PATHOLOGIST-IN-CHIEF

George E. Gardner, M.D.

PSYCHIATRIST-IN-CHIEF

William T. Green, M.D.

ORTHOPEDIC SURGEON-IN-CHIEF

Robert E. Gross, M.D.

SURGEON-IN-CHIEF

Franc D. Ingraham, M.D.
NEUROSURGEON-IN-CHIEF

Charles A. Janeway, M.D.

PHYSICIAN-IN-CHIEF

Edward B. D. Neuhauser, M.D.
RADIOLOGIST-IN-CHIEF

COUNSEL

William N. Swift

AUDITOR

Arthur Andersen

ASSISTANT SECRETARY OF THE BOARD

Miss Antoinette J. Valcnza

THE CHILDREN'S HOSPITAL MEDICAL CENTER

ADMINISTRATIVE STAFF, 1960

Director:

Joseph P. Greer

Assistant Directors:

Lendon Snedeker, M. D.,

FOR PROFESSIONAL SERVICES

Muriel B. Vesey, R. N.,

FOR NURSING SERVICE
AND SCHOOL OF NURSING

Greer Williams,

FOR DEVELOPMENT AND PUBLIC RELATIONS

COMPTROLLER:

Richard E. Held, C. P. A.

FUND DIRECTOR:

Mrs. Anthony T. Michaels

ADMINISTRATIVE ASSISTANT:

Rudman Ham

'Deceased

Administrative Department Heads

Alexander T. Brown,

PERSONNEL DIRECTOR

Salvatore Caliguri,

SUPERVISOR, PRINT SHOP

Miss Shirley Cogland,

DIRECTOR, PHYSICAL THERAPY DEPARTMENT

Frank W. Dickey,

EXECUTIVE HOUSEKEEPER

Miss Ellen Fitzgerald,

PURCHASING AGENT

Mrs. Harriet H. Gibney,

DIRECTOR, PUBLIC INFORMATION

John Glancy,

MANAGER, SURGICAL APPLIANCE SHOP

Miss Marion W. Hall,*

DIRECTOR OF SOCIAL SERVICE

F. R. Harding,

DIRECTOR, VISUAL EDUCATION DEPARTMENT

Mrs. Kathleen Higgins,

DIRECTOR, VOLUNTEER SERVICE

Miss Marcelle Hocquet,

SUPERVISOR, DEPARTMENT OF
PATIENT EDUCATION AND RECREATION

Miss Hester E. Macuen, R. N.,

DIRECTOR, EMPLOYEE HEALTH SERVICE

George T. Nicoll,

DIRECTOR, SPECIAL SERVICES

Mrs. Ruth C. O'Brien,

CHIEF OPERATOR

Miss Dorothy Pratt, R. N.,

SUPERVISOR, OUT-PATIENT DEPARTMENT

Miss Dorothy Rutherford,

SECRETARY, WOMEN'S COMMITTEE

Mrs. Marie Smith, R. R. L.,

DIRECTOR, MEDICAL RECORDS DEPARTMENT

Arthur Stomberg,

PLANT SUPERINTENDENT

Mrs. Martha Stuart,

HEAD DIETICIAN

Arthur M. Thompson,
CHIEF PHARMACIST

PRESIDENT'S MESSAGE

Large voluntary hospitals engaged in teaching and research as well
as care of patients, such as The Children's Hospital Medical Center,
present complex problems of administration. These problems appear
to rise largely from two factors:

1. Such institutions operate not for profit but as a service to the
community and to humanity in general; because the need for service
is prone to outrun available capital and income, these hospitals are
constantly in, or on the verge of, financial crises. Each improvement
in the quality or quantity of service is made at the risk of an unbalanced
budget and further deficit. The twin obligation to provide service to
patients and their families, most of it at less than cost, and yet to
balance the budget presents a paradox alien to the philosophy of the
business man who finds the service he renders no substitute for a profit
if he wishes to continue in business. We have touched here on the
essential although not fully recognized difference between business and
charity. As Mr. Greer indicates in the Director's Report, in a hospital
service is profit, but it still remains to be underwritten by whoever
can afford the dollar loss.

2. A voluntary hospital such as ours may present an anomaly
of leadership and organization: dual management. This is to say it is
legally governed by a lay board to whom the Director is presumed to
be responsible for efficient operation of the hospital; yet the hospital's
professional staff is legally autonomous and therefore to a great extent
self-governing in its practice of medicine within the hospital. Successful
management therefore depends not so much on the delegation of
authority in a straight line of command from board to the staff as on
a spirit of mutual respect and good will. It may come as something
of a surprise to the uninitiated hospital trustee to find that the Director
himself is not finally responsible to the board for operation of the
hospital; rather, it is the professional staff which ultimately decides how
they and therefore the hospital can best serve their patients. Conse-
quently, in the operation of a large voluntary hospital, the Director
must understand and try to implement the principles of sound business
management and yet serve less as an executor of the board's will than

as an ambassador between the board and the professional staff, which
has a well-defined will of its own.

It is in the image of a modern diplomat, who frequently must live
with crisis, endeavoring to carry out the policy of his government
through continuous representation and negotiation, that we might best
think of the position of Director of The Children's Hospital Medical
Center as we read the Director's Report, in the pages following. For
my part, I find both vision and realism, the ideal and the practical,
expressed here in the most challenging communication to come to the
Board from the Hospital during my experience as Trustee and President.
Here we find understanding not only of the changing needs of children
and of The Children's Hospital, but pleasant news that our operating
deficit has been reduced by one third in Mr. Greer's second year as
Director. Here we find not only clear appreciation of the role of the
Trustees and of the growing group of our friends in their support of
the Hospital and the Medical Center, but we also get a frank request for
an even greater effort on our part to strengthen the institution's mission
as one of the greater educational and scientific arms of Harvard Medical
School.

Perhaps we have not been able to extend these efforts and meet
the future as rapidly and progressively as we might, but in 1960 we
made some progress. And we have made this progress, as indicated above,
in one of the most difficult of all areas: hospital administration.

In injecting this particular emphasis in the President's Message, I
do not think anyone will assume that I have overlooked what is and
always has been the secret of our success as a world center of pediatrics.
The need of a child for good health is continuous from infancy through
adolescence; as long as our doctors, nurses, social workers, technicians,
and the many others among our 1,400 employees work to meet this need,
the tremendous vitality, energy, and creativity of our institution will
be self-renewing. Its objectives are clear and the means will be found.

William W. Wolbach, President

TREASURER'S REPORT

The most gratifying feature of the year's financial transactions was
the substantial decrease in the deficit. As shown in the comparative
statement of income, the net loss of $275,000 for the fiscal year ended
September 30, 1960 was $310,000 less than the 1959 deficit of $585,000;
both figures being exclusive of depreciation.

The improvement in operating results in 1960 compared to 1959
is chiefly due to the following increases in revenue:
Patient revenue $379,000

Income from investments 86,000

Allotments from our

affiliated institutions 75,000

$540,000
The increased revenue more than offsets the rise in operating costs
of $248,000. Although active steps were taken during the year to
control costs through budgets, this increase was attributable to salary
and wage increases granted during the year.

The favorable change in gross patient revenue is due to an increase
both in rates and in use of Hospital services. Inpatient rates were
raised $1 per day effective January 1, 1960 and outpatient rates were
raised $1 per visit on April 4, 1960. The increase in the use of the
Hospital is shown in the following comparative operating statistics:

Fiscal Year

Admissions
Patient days
Average daily census
Outpatient visits

excluding psychiatry
Emergency visits included 21,924
Services:

Laboratory tests
X-rays
Operations

On December 1, 1959, in accordance with Chapter 283 of the
Acts of 1959, the following institutions: The Children's Hospital, The
Children's Medical Center, Inc. and Charitable Surgical Appliance Shop
merged into one body known as the children's hospital medical
center. The statement of income shown on the following page reflects
the operations for both fiscal years 1960 and 1959 of these institutions:
The Children's Hospital, Infants' Hospital, Sharon Sanatorium, Hospital
and Convalescent Home for Children, and Association of the House
of the Good Samaritan.

F. Murray Forbes, Jr., Treasurer

1960

1959

9,924

9,919

93,024

91,399

254

250

87,245

86,901

21,924

19,845

126,208

118,642

78,248

74,453

5,616

5,492

THE CHILDREN'S HOSPITAL MEDICAL CENTER

Comparative Statement of Income for the Years Ended September 30, 1960 and 1959

I960 1959

During the year we earned from patient care $4,864,579 $4,485,153

But the amounts not received because of allowances and patients'

inability to pay were 604,393 580,019

Net revenue from services to patients $4,260,186 $3,905,134

We received other operating revenue from:

Meals, rentals, services, School of Nursing $ 361,107 $ 300,947

Overhead allowance on research grants 100,528 77,425

Outside grants for research and education 1,706,701 2,168,336 1,746,759 2,125,131

TOTAL OPERATING REVENUE ' $6,428,522 ~ $6,030,265

We spent or incurred expenditures for patient care:
Salaries, supplies and expenses from:

General funds $6,028,662 $5,740,817

Outside grants for research and education 1,706,701 1,746,759

TOTAL COST OF OPERATING THE HOSPITAL 7,735,363 7,487,576

Since operating revenue did nor equal operating costs, the resulting

LOSS from operation of the Hospital was $1,306,841 $1,457,311

This loss was partially defrayed by income received from these sources:

United Community Services allotment $ 31,257 $ 35,040

Committee of the Permanent Charity Fund 14,000 12,000

Income from investments and trust funds 715,611 629,258

Allotments from affiliated institutions 270,724 1,031,592 195,235 871,533

Net LOSS before depreciation $ 275,249 $ 585,778

Depreciation 370,300 358,828

Net LOSS for year ended September 30 charged against the General Fund $ 645,549 $ 944,606

During the year we also received:

Legacies for general purposes $ 484,885 $ 906,608

Gifts and legacies for restricted endowment 138,261 323,964

The statement of income for the year ended September 30, I960 has been condensed from a report certified to by Arthur Andersen & Co.

/ I j^f

"... the need for our chief products —
pediatricians, pediatric nurses, and pediatric
knowledge has increased ..."

DIRECTOR'S REPORT

Changing Needs of Children

Children, it has been remarked, are not ordinarily aware of change.
While, if granted good health, they grow physically and develop men-
tally day by day, the world around them appears to them constant,
everlasting. But we who are adults and assume responsibility for children
— their parents, guardians, teachers, physicians, nurses — are aware that
the world as it affects children changes rapidly. An institution which
would serve the world of children, as The Children's Hospital Medical
Center does, has no choice but to change with it, or else fail in its mission.

Some of the dimensions of change are well-known. For example, the
infant death rate — the number of babies who are born alive but die
within the first year — has dropped more than 70 per cent since 1915.
Beyond the first year, the risk of death likewise has greatly declined. The
chance of a person surviving all the hazards of infancy, childhood, and
adulthood and of reaching at least the age of 60 has increased from less
than 50 per cent in 1900 to more than 75 per cent today. Even for those
beyond 60, the outlook is much improved. The average expectancy at
60 is for 17.5 more years of life; at 75, for 8.7 more years.

The opportunity for longer, healthier, and more comfortable lives
provided by the medical, agricultural, and industrial sciences has pro-
duced profound effects. We are aware of the "vitamin kids," the boys and
girls who grow taller and larger than their parents. We have heard much
of the aging of the population and more recently, partly in reflection of
the somewhat higher birth rate of the last twenty years, of its "younging."
The proportions both of children and of older persons to that part of
the population in the productive, middle years have increased, implying
that those of breadwinning and homemaking age — the parents of our
patients — may be increasingly caught in an economic squeeze.

The nation has become concerned with the population "explosion"
as it is called — a direct result of medical science's multiplying talents
for keeping children alive. Within the lifetime of some of the Trustees
of The Children's Hospital, the population of the United States has
tripled. The total number of children has increased, the number of chil-
dren per family has increased, and the proportion of children to total
population has increased. Thus, the need for our chief products — pedia-
tricians, pediatric nurses, and pediatric knowledge — has increased com-
mensurately. Indeed, more than one of every three Americans, or about
70,000,000, is in the age range served by The Children's Hospital Medical
Center — that is, 19 or under.

One blessing of the increased life expectancy is well known to our
doctors and social workers who are in day to day contact with children
and their parents, but is of interest to the public, and particularly those
who engage in the planning and operation of community services. This
is the "vanishing orphan." Forty years ago, 1.9 per cent of the nation's

child population had no mother or father; the figure is now 0.1 per cent
— a 94.7 per cent decrease. In 1920, 16.3 per cent of children under 18
had lost either their mother or father through death; in 1958, the per-
centage was only 4.5. Thus it is that The Children's Hospital and the
family of affiliated institutions making up its Medical Center must sup-
ply the staff and basic facilities for treating more and more children who
come to us from an intact home and need spend only a brief time with
us.

Another aspect of longer life is the emergence of new medical prob-
lems as older ones are solved. In 1900, the principal killers of children
were pneumonia, tuberculosis, and gastrointestinal infections. These in-
fections still persist, in reduced numbers, but no longer present a great
threat to life, thanks to the antibiotics and other health-restoring mea-
sures. The child with pneumonia is commonly treated at home and re-
covers quickly. Likewise, some of the principal child cripplers of former
times — tuberculosis of the bone and osteomyelitis, for example — have
diminished in importance as the result of effective, early treatment. In
1960, the Hospital had one of it lightest years in the treatment of new
cases of paralytic polio. This is not only a dramatic example of change
but of the role of The Children's Hospital Medical Center in bringing
change about, for it was here that the basic discovery of a method of
cultivating polio virus was made; this break-through opened the way for
the Salk vaccine. The wider use of the present or of improved vaccines
will surely bring about the control of this dread disease and so eradicate a
leading cause of orthopedic handicaps.

Today, different pediatric problems have come to the fore. Acci-
dents, cancer, and congenital malformations are now the leading killers
of children. Each of these disasters of children, particularly accidents
and birth defects, are major cripplers as well as killers. As children are
saved from infections and as the population grows, the number coming
to the Hospital with some form of cancer or with a congenital disease
increases.

In 1960, at a meeting of the American Public Health Association,
Dr. Sidney Farber, Pathologist-in-Chief, reviewed developments in the
chemotherapy and care of the cancer patient. Since he first introduced
the antimetabolite drug, aminopterin, in the treatment of acute leukemia
in children at this hospital in 1947, it has been possible to produce tem-
porary (but as yet not permanent) recoveries. A few children have been
kept alive from three to eight years after onset of their illness. Exciting
progress also has been made here in the treatment of a cancer of the kidney
with the antibiotic, Actinomycin D, in combination with small amounts
of radiation. Children so treated are apparently normal and free of evi-
dence of the tumor three years later, even though treatment was not un-
dertaken until the disease had spread to their lungs.

Childhood cancer remains one of the most important frontiers in

"... different pediatric problems have
come to the fore ..."

"... a medical center which was
predominantly an in-patient hos-
pital is becoming a complex of spe-
cialized outpatient clinics ..."

medical research; the program being carried out at The Children's
Hospital Medical Center by an affiliated institution, the Children's Cancer
Research Foundation, is commensurate to the size of the problem. We are
the world center in the care and study of childhood cancer.

Studies have shown that 5 per cent of all infants born alive have
major congenital malformations of some sort, the most common being
defects of the heart or major blood vessels, urinary tract, and intestines.
Many of these defects are completely correctable through techniques of
surgery in which Dr. Robert E. Gross, Surgeon-in-Chief, has pioneered
at The Children's Hospital; in still other cases, disability can be greatly
reduced. As Dr. Gross notes in his annual report, 1,818 operations for
corrections of malformations were performed in the Department of Sur-
gery alone during 1960. A large number of these operations, particularly
those involving the open heart, could not have been attempted a decade
ago. Now the child may undergo heart surgery and be back home in two
weeks. Still other congenital defects present problems for solution by the
orthopedic surgeon, the neurosurgeon, the neurologist, or others.

Anyone familiar with the long and varied record of original scientific
contributions emanating from The Children's Hospital and its affiliated
institutions will recognize that we have hastened change. This change
affects the Hospital itself as much as it affects children. One further ex-
ample will suffice for the moment: The Children's Hospital began ninety-
one years ago principally as a service to physically crippled children who
occupied beds, often for long periods of time. Orthopedics, the specialized
treatment of bone and joint diseases, was first developed here as a recog-
nized specialty and, throughout its history, the Hospital has been a world
leader in this field. Thanks to improvements in methods and systems of
treatment and rehabilitation, however, a large number of orthopedic
patients require relatively short periods of hospitalization and then can
be treated in our orthopedic out-patient clinic and sent home after each
visit. Still others require no hospitalization at all. In this way, our doctors
can care for more patients and at a lower cost to parents.

The same situation applies in other departments. For instance, Dr.
George E. Gardner, Psychiatrist-in-Chief, in his annual report, provides
us with a comprehensive description of the development of psychiatric
out-patient services at the Hospital matching in-patient services available
at the Judge Baker Guidance Center. Other clinics are too numerous to
mention in this brief discussion but include fields of easily recognized im-
portance — cerebral palsy, cystic fibrosis, epilepsy, speech and hearing de-
fects, allergies, to cite a few. As a consequence of these developments,
we have witnessed the phenomenon in the last ten years of a medical
center which was primarily an in-patient hospital, convalescent home,
and, in some instances, school for chronically ill children, becoming pre-
dominantly a complex of specialized clinics — forty-one all told. Tabula-
tion of 20,513 individual patients coming to the Hospital during the

fiscal year* ending September 30, 1960, showed that 10,871, or 53 per
cent, were clinic patients and 9,642, or 47 per cent, were bed patients.

Plainly, as we shall further elaborate, the advances that the Hospital,
its staff, and its affiliates have scored through scientific research, through
the training of child specialists, and through direct services to children
have only served to broaden and deepen our responsibilities in a changing
world. One is apt to think of an old hospital as having a Gibraltar-like
fixity — as an established, material, and persistent element in the life of its
community. Actually, The Children's has this kind of stability only in
the continuity of its mission of service to children. Otherwise, it is the em-
bodiment of the changing needs of children. It must remain so, and indeed
must move more rapidly in meeting change than it has heretofore, if it
is to continue to fulfill its mission. In summation, we feel that the words
used by Dr. George P. Berry, Dean of the Harvard Medical School, exactly
fit our own situation: ". . . No institution can afford to live off the capi-
tal of tradition. None know better than those who labor here that history
is a bank account which must be constantly renewed. . . ."

Dimensions of Service

The Children's Hospital Medical Center serves the world of children
in many directions and a variety of dimensions.

The most obvious dimension is the direct care of children. Whereas
we are sometimes known as The Children's Hospital of Boston, the ac-
companying chart showing the sources of our patients demonstrates the
extent to which we are a community, state, national, and world institu-
tion. We serve children everywhere, and many more from outside Boston
than from within it. Last year, 13,701 of our 20,514 hospital and clinic
patients came from outside of Boston, 11,381 from elsewhere in Massa-
chusetts, 2,190 from elsewhere in the United States (many from neigh-
boring New England states), and 130 from elsewhere in the world. For
the most part, those coming from abroad present complicated problems
of diagnosis and treatment, either due to the rarity of their disease, the
obscurity of signs and symptoms, or the lack of generally effective knowl-
edge of how to proceed. By no means all these children have a hopeful
outlook, but, as Dr. Charles A. Janeway, Physician-in-Chief, observes in
his annual report, our Hospital becomes the court of last resort. The
general assumption is that our pediatric scientists, working at the growing
edge of knowledge, may find a solution where others cannot. At the same
time, we render some types of service that are largely local or regional in
nature; our emergency clinic continued to grow last year, as it has for the
last decade, as a first line of defense against accident injuries and other
acute conditions.

world

"... our pediatric scientists may find a
solution ..."

*CHMC recognizes two different years — an academic year ending June 30, a hos-
pital accounting year ending September 30.

SOURCE OF CHILDREN'S HOSPITAL PATIENTS BY PLACE OF RESIDENCE

For the Year Ending September 30, 1960

MASSACHUSETTS

18,194

Boston

ELSEWHERE IN MASSACHUSETTS:

Barnstable County 129

Berkshire County 101

Bristol County 597

Dukes County 4

Essex County 1,290

Franklin County 59

Hampden County 643

Hampshire County
Middlesex County
Nantucket County
Norfolk County
Plymouth County
Suffolk County
Worcester County

6,813

11,381

4,581

2,045

651

634

558

ELSEWHERE IN THE UNITED STATES:

2,190

Alabama

Missouri

Alaska

Montana

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Arizona

Nebraska

->, .

Arkansas

New Hampshire

431

California

New Jersey

Colorado

New York

214

Connecticut

367

North Carolina

District of Columbia

Ohio

Florida

Oklahoma

Georgia

Pennsylvania

Idaho

Puerto Rico

Illinois

Rhode Island

412

Indiana

South Carolina

Iowa

Tennessee

Kansas

Texas

Kentucky

Vermont

Louisiana

Virginia

Maine

359

Washington

Maryland

West Virginia

Michigan

Wisconsin

Minnesota

Wyoming

ELSEWHERE

IN the world:

130

Africa

Europe

Asia

Mexico

, / J

Canada

South America

Central America

West Indies
grand total

20,514

A second dimension of service, also obvious, is that of a training
center, as part of Harvard Medical School. Dr. Edward B. D. Neuhauser,
Radiologist-in-Chief, points out in his annual report that, when the So-
ciety of Pediatric Radiology was formed last year, two thirds of the
charter members were found to have obtained their resident training in
pediatric radiology at The Children's Hospital. The program of Dr.
William T. Green, Orthopedic Surgeon-in-Chief , for the resident training
of orthopedic surgeons is one of the most, if not the most, sought-after
in the country; many of the professors of orthopedics in other medical
centers have been trained here. Dr. Gardner heads one of the world's
largest centers for the training of child psychiatrists, a specialty in which
the nation is in extremely short supply. The Department of Medicine,
under Dr. Janeway, conducts the largest teaching program in the C. H.
M. C. and, as it pertains to pediatricians, one of the largest in the world.
These examples could be extended to include other specialties and other
professions than medicine. At all times, we have, in addition to the regular
professional staff, more than 200 doctors and nearly 200 student nurses
in training in The Children's Hospital. A substantial proportion of the
doctors come from abroad.

Our educational responsibilities recently have extended into hospital
administration. In June, Mr. Aslam Gundas, administrator of the Chil-
dren's Hospital in Ankara, Turkey, came here under the sponsorship of
the Rockefeller Foundation for a one-year tour as administrative resident,
following a year at the University of Chicago Clinics.

A third and likewise obvious dimension of service is scientific re-
search. It is not possible to detail here the long list of scientific "firsts" that
have occurred in The Children's Hospital Medical Center. They range
from the several Gross heart and blood vessel operations and the several
brain operations developed by Dr. Franc D. Ingraham, Neurosurgeon-in-
Chief, to basic knowledge of blood and neurological diseases and bone
growth worked out by others, among them Dr. Louis K. Diamond, the
late Dr. Bronson Crothers, and Dr. Green. The "iron lung" was developed
here; so was the life-saving blood replacement tranfusion for "Rh babies."
Our firsts include the Nobel Prize-winning work of Dr. John Enders'
Laboratory; Enders and his associates not only were first to cultivate polio
virus in non-nervous tissue, making a polio vaccine possible, but more re-
cently have attenuated the measles virus and developed a measles vaccine
now undergoing clinical trials.

The Children's Hospital Medical Center research and educational
programs receive $1,700,000 a year in outside grants, exclusive of the
programs operated independently by the Children's Cancer Research
Foundation and the Judge Baker Guidance Center. Inclusion of the
latters' research programs would bring the total to more than $3,000,000.

Other dimensions of service are not so well recognized or so well
financed but are no less valuable to humanity. There are, for example,

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. . A training center ..."

"... A long list of firsts in scien-
tific research ..."

heart and blood vessel

operations .

"... the basic knowledge of
bone growth ..."

"... the lifesaving blood re-
placement for Rh babies ..."

"... An institution whose mem-
bers are deeply involved both as
experts and good citizens in the
life of this country ..."

what we haven chosen from the administrative viewpoint, to call the un-
seen, or silent, services; they are, at any rate, wholly voluntary and largely
unsupported from outside sources. Perhaps the best example is the free
consultations that our staff of 250 physicians give, as a matter of custom
and a function of leadership. Daily, every department receives requests by
letter or telephone from doctors all over the world for an expert opinion
on diagnosis or treatment of difficult cases.

One might visualize the busy professor of pediatrics as constantly
moving from one child to another in a crowded clinic, or making ward
rounds in the hospital, but the many visitors to the office of Dr. Janeway
are struck by the fact that one of his chief functions is as an answering
service. There are the many interruptions as he takes long-distance calls
— perhaps to help a parent find a good pediatrician in Madras, Cairo, or
Dallas. In his annual report, he points out how many members of his
staff make contributions in the public interest as trustees, chairmen, or
committee members of various charitable organizations of local or na-
tional scope. "This is no ivory tower," Dr. Janeway remarks, "but an in-
stitution whose members are deeply involved both as experts and good
citizens in the life of this country."

Dr. Gross devotes several weeks a year to evaluating candidates
for certification as specialists and for surgical society membership.
He gives free consultation by mail, spending from twenty to thirty hours
a month on from sixty to eighty case histories referred to him from
various parts of the world. Dr. Farber's department receives some ten
telephone calls a day for free consultation on questions of pathology. Dr.
Neuhauser, who gave twenty-two lectures on radiology at meetings out-
side of Boston in 1960, receives X-ray films by mail with requests for his
expert opinion; he estimates that he gives about 100 such free consulta-
tions a year. Dr. Gardner estimates that he spends 30 per cent of his time
answering questions by letter, telephone, or personal interview. These
mainly involve helping parents find psychiatric treatment for their chil-
dren in this country or abroad and advising students where to seek psy^
chiatric training. Much of this free consultative work is carried on even-
ings, holidays, and weekends, in addition to his responsibilities as a clini-
cian, teachers, researcher, editor, and administrator. Dr. Green, who shares
with other Chiefs the energy and motivation to work almost continuously,
is in great demand as an educator in orthopedics; last year, despite three
weeks as a hospital patient himself, he was lecturer or moderator at
twenty-eight meetings in nine states, not counting five lectures during a
two-week trip to Brazil. Our doctors travel throughout the world, to give
courses in Scotland, to make investigations in Africa, to survey Russian
progress in infant care, to speak at an international meeting in Japan, and
so on. They are in addition editors of a large number of professional
journals.

Several of the staff serve as advisers or consultants to various agencies

of the Federal Government, among them Dr. Ingraham, Dr. Gardner,
and Dr. Janeway, as well as others. For example, Dr. Farber is a member
of the National Advisory Health Council, and served on the Jones
Committee, which made recommendations for a Federal medical re-
search program emphasizing long-term support of medical scientists
and research centers throughout the country. This program has been
to a great extent enacted. But we are tempted to digress here to
point out that, while scientific discoveries are a major source of the
fame of The Children's Hospital and therefore research support is
of prime importance, the increased availability of monies for research
enlarges, rather than reduces, the Hospital's need for capital funds,
which will be mentioned later. In addition, the Hospital is represented
in the leadership of most, if not all, of the major national voluntary
health organizations — for example, by Dr. Gross, in heart; Dr. William
Berenberg, in cerebral palsy; and Dr. Harry Shwachman, in cystic
fibrosis.

We have provided no more than fragmentary sampling of the unseen
services, or outside activities, of our staff. Yet the examples given should
be enough to illustrate what demands the public, medicine, and science
make upon the Hospital because of its reputation as a national and inter-
national resource in child health. We can applaud the civic participation
and professional leadership of our staff, take great pride in their capacity
to accelerate progress in science and education, and take full cognizance
of the spiritual satisfactions to be derived from such contributions; yet
we remain aware that outside demands on staff time are a tax on the
primary service function of the Hospital. In this special sense, we are not
a tax-exempt corporation, any more than we are a self-sufficient enter-
prise that can live and flourish solely through its own efforts. Indeed, for
our economic survival, we are dependent on legacies and large gifts repre-
senting both the last testaments and living testimonials of the Hospital's
many good friends — expressions of their faith in the soundness of its mis-
sion and the certainty that its service in the future will equal or surpass
that in the past.

The responsibilities which leadership in the pediatric sciences impose
on our senior staff, not only in their personal contributions and services to
children and in their own activities as teachers and scientific investigators,
but equally so in their service on advisory boards and committees of gov-
ernmental and voluntary agencies, have increased to the highest point
in the history of the Hospital. This increase, bringing even the most
gifted and energetic man to the threshold of fatigue, beyond which he
cannot function efficiently, emphasizes the need for strengthening our
medical staff in many quarters. The solution, the many discussions of the
Staff's Planning Committee have indicated, appears to lie in more
adequate staffing and financial support in depth — double-staffing of
senior men in full-time positions — plus increased space to accommodate

"... much of this free consultative
work is carried on evenings, holidays
and weekends ..."

"... almost continuously in de-
mand as an educator in orthope-
dics ..."

A bold new program emphasizing

additional staff and some changes in concepts of hospital and depart-
mental management to achieve more effective delegation of authority.
But such a solution would require a greater availability of assured income
for creating and maintaining permanent staff positions — positions in-
finitely preferable from both the scholar-physician's and hospital's view-
point. We are reminded of the axiom in business management that the
first task of a new president of a corporation is to choose his successor.
This would be easy enough to do at The Children's Hospital, some of our
Chiefs of Staff have remarked, /'/ ive had the money. In contrast, many
of our senior men have been obliged to raise themselves and their depart-
ments by their professional bootstraps, depending on private practice not
only to support themselves but some part of their teaching and research
programs.

At present, we have not a single professorship that is adequately

long-term support of medical scientists and endowed; the chairs held by Drs. Janeway and Gross are supported only
research centers ... on a partial basis and therefor require considerable strengthening. In

addition to these, we could use ten fully endowed faculty positions,
including both full and associate professorships with the doctor's basic
income provided at no cost to the Hospital. The medical staff presently
receives some funds from the Medical School, but our teaching program
is not as strongly supported as it should be in any department.

The creation of endowed professorships provides a method by which
teaching can pay its own way, and enable the donor to invest in a posi-
tion that will perpetually strengthen the Hospital in its services to
patients. In 1960, we were fortunate in being able to take one step
toward augmenting our senior staff. We received from a donor who
wishes to remain anonymous securities valued at $450,000. After careful
consideration by the Planning Committee of the Staff in consultation
with the donor and the Trustees, the decision was to ask the Medical
Faculty of Harvard to establish a chair in child neurology at The Chil-
dren's Hospital as a focus for a new program of neurological research,
constituting an attack on some of the major causes of crippling and
death in children, including hereditary afflictions and the accidental
defects of gestation and birth. This will constitute a contribution to the
Harvard Medical Center's program to strengthen the medical faculty.
In this connection, it is of interest to note the scheme devised by
the School's Office of Development to enable smaller foundations and
voluntary agencies to create professorships, that is to make a tangible
investment in people on a pay-as-you-go basis. The proposal is simply
that the donor commit himself to give the Harvard Medical Center
$60,000 a year for ten years; of this amount $2 5,000 is used currently
during this period to pay the professor's salary, and Harvard University
invests the remaining $3 5,000 at 5 per cent; at the end of ten years, the
professorship becomes fully endowed and meanwhile the incumbent has
pursued an active career of research, teaching, and service. In a manner

of speaking, this is a way of having one's philanthropic cake and eating
it, too. An additional attraction from the giver's standpoint is that the
scholar-physician holding a $25,000-a-year professorship can attract
Federal and voluntary research grants in the range of $250,000 to
$500,000. In this way, the original endowment becomes a prime mover
in a full-scale program in a given field.

Planning for the Unpredictable

Our Medical Center is a general hospital for children. The business
of a general hospital that serves its community is threefold: It is to meet
human crises as they occur, to provide continuous care of the sick as
they need it, and to engage in a broad program of disease prevention
and health promotion. That it will need to do these things and do them
well is wholly predictable. We must be prepared to meet all emergencies
as they occur, and yet we do not know what the emergency will be until
it arrives. We must be prepared to apply the latest scientific advances
in disease prevention or treatment, but we do not know what they will
be until they are discovered.

We find a ready example in poliomyelitis. The Massachusetts polio
epidemic of 195 5, which threw a great burden on our facilities as a state
and regional center for the treatment of infantile paralysis, was un-
predictable. The laboratory break-through that made the polio vaccine
and the ultimate control of the disease possible also was unpredictable
in time of discovery. An epidemic may fill a hospital's wards: a vaccine
or the mere absence of epidemics may in time empty them.

The same situation may be observed in heart surgery. It has been
estimated that a quarter million children have congenital heart defects
cheating them of a robust childhood or of life itself. Only a few of these
defects could be repaired prior to open-heart surgery. Dr. Gross has
pointed out that the development of open-heart surgery did not be-
gin until a surgeon at the University of Minnesota chanced to read in
a British medical journal of some successful experiments in the cross-
circulation of blood in dogs, a sort of continuous transfusion in which
the heart of one would do the work for two. The first open-heart sur-
gery in humans was done in this way, with a parent's circulation being
linked to his child's. Heart surgeons realized what could be accomplished
by using standby heart and lungs while the patient's heart was stopped.
Efforts to perfect a heart-lung machine, pioneered at Jefferson Medical
College, were redoubled, here and elsewhere, with rapid success. Today,
surgery on the open heart, while complex and requiring great skill and
teamwork, is a commonplace at this Hospital. Operations can be carried
out on 75 per cent of all malformations of the heart and major blood
vessels observed in children over one year of age. In his annual report,
Dr. Gross points out the effect on the surgical caseload in this Hospital.
We witness quickly rising curves in the numbers of new types of opera-
tions, followed by drop-offs. What happens, he observes, is that when

"... An epidemic may fill a hospi-
tal's wards; a vaccine may in time
empty them ..."

"... We must be prepared to apply
the latest scientific advances but we
don't know what they will be until
they are discovered ..."

"... when
is developed at

a new surgical technique
Children's Hospital ..."

a surgical technique is originated or developed at The Children's Hos-
pital it attracts patients for a time but, when the technique is adopted
by surgeons in general hospitals elsewhere, our patient load in this di-
rection drops off.

This is how medical science progresses. The cost of progress, in
economic terms, can be read not only in the rise and fall of patient
revenues from different services but the Director's seeming obsession
with an unpleasant topic: money. In 1960, the Hospital admitted 9,924
patients for bed care, about the same as 1959 (9,919) but these patients
stayed a little longer on the average, 9.3 versus 9.2 days (including
convalescent patients). With a bed capacity of 3 54, the average daily
in-patient census was 254 (71.8 per cent) against 250 (70.7 per cent)
the year before. It is impossible to operate any hospital at 100 per cent
of capacity, but a 10 per cent increase — to 80 per cent or so — would
have completely wiped out our 1960 operating deficit of $275,250 and
left a substantial sum for other purposes, such as the payment of house
officers' salaries or the improvement and expansion of clinic and research
facilities.

Miss Muriel B. Vesey, in her annual report as Director of the Nurs-
ing Service, deals with another element of unpredictability in hospital
operation: personnel turnover. We have a regrettably high rate of
turnover in our nursing staff. Many nurses are prone to leave in the early
part of the summer. This is the time when our in-patient census rises
to its highest peak, due to the fact that parents bring in their children
for elective surgery at the close of the school term (we tend to reach an
annual high in June and annnual lows in September and December).
Asks Miss Vesey: "Does one attempt to staff for the peak or try to
strike an average?" Neither approach is wholly satisfactory. While the
turnover is most serious in nursing (children require more nursing than
adults) , the problem is not confined to nursing. Mr. Alexander Brown,
Personnel Director, points out in his annual report that 600 employees
left C. H. M. C. in 1960; this is close to a 50 per cent rate of turnover.
This phenomenon is not uncommon among hospitals — due in part to
their low salary scale, insufficient staffing, and inequitable work loads
— but it is costly, both in the dollars-and-cents expenses of hiring and
training and in operating efficiency. Through study and revision of
personnel policies, the Administration is endeavoring to improve the
situation. Wage and salary increases in the last year totaled $175,000.
We may expect a continued upward trend in payroll.

A moment ago, we mentioned the house officer salary and working
space problems. We did so deliberately, although not without misgivings
for they both have become sensitive areas in this Hospital.

The Children's Hospital Medical Center is, insofar as we know,
the last teaching hospital in the country without a salary program for
the support of interns and residents — the house staff. At one time it was

an occasion for pride to state that the opportunity for training at The
Children's Hospital was so attractive to the medical graduates of the
nation they would come without pay. Today, the climate of opinion
regarding the sacrifice has changed. We fully agree that a teaching
hospital should pay its house officers at least a modest stipend, over and
above the traditional board, room, and laundry. Many are married; some
have children; many have already incurred debts for their medical
schooling. In addition, lesser hospitals offer fairly attractive sums in order
to attract house officers.

In 1960, impetus for payment of house officers arose with the
Trustees' establishment of the John Wells Farley Memorial Fund, in
honor of the late Chairman of the Children's Medical Center
Board of Trustees. The proposal was to raise money for an endowment,
the income of which would be used as the nucleus of a house officer
salary program. To lead the way, Mike Farley's friends raised more than
$100,000 in his memory. It was recognized that endowment for a total
program would fall in the neighborhood of $5,000,000 and therefore it
probably would be necessary to find the resources in ways other than
endowment alone.

As the year ended, a survey by the Office of Development showed
that of 106 house officers logically entitled to compensation for their
services to the Hospital, 61 received annual amounts varying from $1,000
to $7000 and 45 received nothing. The breakdown by departments is
instructive:

PAID NOT PAID TOTAL

Medicine

Radiology

Surgery

Orthopedics

Anesthesia

Psychiatry

Neurosurgery

Dentistry

Pathology

GRAND TOTALS

106

It is obvious that those least apt, or able, to pay their interns and
residents are Medicine, Pathology, and Orthopedics. The survey found
that the Hospital currently paid $43,392 a year in house officer salaries,
whereas $118,514 was paid from other funds (of a temporary or
special nature). Under the salary scale contemplated, it appears that
a house officers' salary budget would total approximately $275,000 a
year.

Consideration of the solution by the Board of Trustees was pending
as the year closed.

The second topic of interest here is the problem of space — not outer
but inner space, specifically floor space. There is a growing — indeed,
now crying — need for expanded facilities for clinics and for research.
These are two needs, really; they are equally pressing, and will become

"... In I960, impetus for payment
of house officers arose with the establish-
ment of the John Wells Farley Memorial
Fund ..."

"... better physical arrangements
for our ambulatory services ..."

more so within the next year or two. The Cardiology Division under Dr.
Alexander Nadas, which supplies the diagnostic foundation for heart
surgery, cannot expand, and indeed is blocked from obtaining a large
Federal grant for operation of a cardiology research center by lack of
space. The anticipated appointment of a professor of child neurology,
as mentioned earlier, will compound the problem. He will need a lab-
oratory and offices for himself and his staff. Large grants for neuro-
chemical and neurophysiological research are obtainable from both pub-
lic and voluntary sources, such as the National Institute of Neurological
Diseases and Blindness and the National Foundation. They depend in
this case on bricks and mortar.

Many other examples of a space bind could be cited, but the most
critical one administratively is in facilities for the diagnosis and treat-
ment of out-patients. Our forty-one clinics are presently scattered, mak-
ing for uneconomical operation from a bookkeeping and transaction
standpoint; they are tucked around, wherever a room or two could be
found. Our main Out-Patient Department in the old Hospital (Building
A) is converted in-patient facilities. Many different departmental services
have been crowded into this space; anyone who has visited our "OPD,"
as we term it, would agree that it was not in keeping from the standpoint
of utility or comfort with our newer facilities, even though some small
improvements have been undertaken. Among other things, we lack
comfortable waiting rooms for the parents, usually mothers but some-
times fathers and occasionally mothers and fathers who crowd the few
benches and chairs with their children, often not only with the patient
himself but other members of the family as well. It has been most diffi-
cult to maintain a spirit of sympathetic understanding and good public
relations under such circumstances. There have been complaints. Where
a sick child is involved, parental emotions are involved. Some criticisms
have been well founded.

Dr. Janeway's annual report clearly depicts the source of our em-
barrassment. The Medical Department has witnessed a 72 per cent
growth in its out-patient load in the last fourteen years, in contrast to
a 32 per cent decrease in acute in-patient admissions and a 42 per cent
decrease in days in the hospital. The decreases in admissions of and
hospital stay of chronically ill children have been even greater. Yet the
most recent construction, itself sorely needed at the time it was completed
in 1954, was primarily for in-patient facilities.

It was chiefly to provide funds for a new clinic and research build-
ing, linking the present old and new Hospital buildings, that our present
limited annual fund-raising campaign — the December Appeal — was be-
gun six years ago. Some $2.3 million now has been raised, exclusive of
a promise of $700,000 from the Federal government. Approximately
$500,000 was added in 1960. Original plans for the building have be-
come obsolete, however, and the first estimate of the cost of this small

building — $4,000,000 — is subject to upward revision.

Beginning of construction has been delayed in the face of the fact
that, as Mr. Wolbach pointed out, a new building would increase Hos-
pital operating costs at a time when the annual deficit threatened to
reach $1 million. This is a dubious distinction that the Director hopes
never to achieve. Decision to go ahead on the Clinic and Research build-
ing more recently has been delayed pending clarification of (1) the
objectives of the Harvard Medical Center and its $58,000,000 Program
for Harvard Medicine and (2) discussions of a new combined hospital
building, or hospital complex, furnishing combined facilities for several
of the teaching hospitals adjacent to the Medical School. Whereas The
Children's Hospital Medical Center fully believes in and is committed
to pursue its own destiny, as a separate institution, it for many years
has worked cooperatively with other Harvard teaching hospitals and
would be willing to extend areas of joint activity where integration of
efforts would improve service to patients and effect economies or im-
prove efficiency.

As a result of information furnished to the Trustees and Chiefs of
Staff by Dean Berry and members of his staff, it is now clear that the
area in which the Hospital and School can most effectively cooperate is
in the raising of funds (1) for the endowment of professors working
in the Hospital and (2) for strengthening departmental staffs associated
with these professors. This effort in fact is the sole purpose of the Pro-
gram for Harvard Medicine (beyond endowment of a new Medical
Library, already accomplished). Dr. Berry has made it clear that brick-
and-mortar problems rest with the hospitals, and that they should pro-
ceed in construction and its financing in any way they see fit.

It is now possible to perceive the advent of a combined hospital
building as a long-range goal of the Peter Bent Brigham and other
interested hospitals, something which will consume some years in its
realization; hence it is easy to recognize that this objective offers no
solution for our own space problem. The need for a Clinic and Research
Building is so short in range it would seem to be point blank. We need
such a construction, costing perhaps as much as $6 to $7 million, im-
mediately. It remains to be determined what it will contain and how it
will be fully financed. But these decisions should be reached in 1961.
This brief discussion of the many variables that affect sound planning
and development for the future documents our earlier point that the
needs of children change and therefore the needs of a children's hospital
change. This much is predictable. But that, we may sum up, is about all
that is predictable. Exactly what changes will occur and what the future
will hold is a question that continually perplexes the governing officers,
the administrative staff, and the medical staff of the Hospital. One other
thing is wholly predictable, by the way — the cost of operations will
continue to rise.

"... brick and mortar
with the hospitals ..."

problems rest

"... the greatest source of
higher costs is our investment in
highly skilled personnel ..."

Costs: Every Hospital's Headache

During 1960, the administration completed its installation of a new-
accounting system aimed at accurate determination of the cost of pa-
tient care, of teaching, and of research. On the basis of this system, known
as responsibility accounting, we began developing departmental budgets
that, when in full operation, will enable the Hospital to present the
Trustees with a complete analysis of accurately identified costs of opera-
tion, making it possible to eliminate unnecessary expenses and properly
allocate financial responsibility for necessary expenses.

The American Hospital Association has estimated that the costs of
operating hospitals have risen 50 per cent in the last ten years, and will
rise as much again in the next ten. We estimate that our costs rose 60
per cent in the last decade, and will go up 60 to 70 per cent in the next
ten years. The greatest source of higher costs is salaries, which make up
70 per cent of the ordinary hospital's budget; in the first-class care of
children, the pediatric hospital often finds its personnel costs exceeding
that percentage, since the ratio of employees per patient must be higher;
in fact, with a payroll of 1,400 employees, the Children's Hospital ratio
of employees to patients is more than twice as high as the average general
hospital. Where the national average hospital cost per patient per day
was $31 (1959), our cost in 1960 was $45; board and room amounted
to $30 and diagnostic and therapeutic service charges to $15 a day.

As the Treasurer's Report shows, The Children's Hospital Medical
Center was able to increase its gross patient revenue $306,000 in 1960
despite a $175,000 jump in operating costs (wage and salary increases),
largely by increasing in-patient rates from $26 to $27 a day and out-
patient fees from $3 to $4 per visit and meanwhile rendering a slightly
greater amount of patient services than the year before.

Since the total annual deficit charged against the general fund was
reduced approximately $300,000 by this experience (plus a somewhat
larger return on investments and increased allotments from affiliated
institutions) , one might well ask why not raise the rates to a point where
we could make ends meet. We may feel forced to recommend another
small increase in the coming year in order to improve our operating
position and to reduce the destruction of capital — the invaluable "hard
money" that all medical institutions these days find so hard to come by.

As the result of improved administrative statistics, however, we can
provide one good reason why we should try to avoid further rate increases
as long as possible and preferably find increased resources elsewhere.

In 195 8, the Department of Commerce informs us, the average
American family had an income of $6220. Analysis of data obtained in
admission interviews by the Comptroller's Office revealed that 68 per
cent of the families of our in-patients and 75 per cent of the families of
our out-patients earned less than this national average. Where only one
out of three American families fall in the $2000-$6000 salary class, two

out of three of the families of Children's Hospital patients fall in this
class. The ratio is three out of four in the case of out-patients' families.
The median range of family income for in-patients is $4940-$ 5200 and,
for out-patients, $4420-$4680.

Fifty per cent of our in-patients are covered by some form of Blue
Cross prepaid hospitalization, the most popular plan being one that pays
$15 a day against our $27 charge for board and room and pays $15.97 a
day for ancillary services, leaving the parents with $12 a day to be paid
out of pocket, or the Hospital in the position of subsidizing about $14
of the $45-a-day cost of operation.

Beyond the 50 per cent who have Blue Cross, 20 per cent have other
forms of hospital insurance, 18 per cent are welfare cases paid at agreed
rates much less than cost, and 12 per cent receive free care.

Blue Cross or Blue Shield provide only a minimum of coverage for
out-patients, the benefits usually applying only in emergency cases or
the treatment of fractures.

From these remarks, it may seem that The Children's Hospital
Medical Center, despite what appear to many to be high rates, serves a
preponderantly lower middle-class economic group at revenue-producing
levels considerable below cost. Indeed, with an operating revenue of
$6,3 5 5,699 in 1960, the level was $1,306,843 below cost. As offsets, we
received a total of $31,257 from the United Community Services and
$14,000 from the Committee on the Permanent Charity Fund. Con-
sidering that we are a private hospital receiving no public tax support,
it may be concluded that the Hospital is rendering a truly charitable,
philanthropic, and humanitarian service to its community.

That we are able to do so, by providing an immediate service to more
than 20,000 children and immeasurable services to the children of the na-
tion and the world who benefit from knowledge developed or imparted
in our institution, is a tribute to the generosity of our Trustees and our
friends, more than 14,000 of whom made gifts to the Hospital in 1960.
It is simultaneously a tribute, it goes almost without saying, to our
doctors, nurses, social workers, technicians, volunteers, and many other
employees who have upheld the tradition that we take care of children,
as they come, and only secondarily concern ourselves with the cost of this
care. It is the responsibility of the Director to accept this secondary
concern, but he would be a foolish hospital administrator indeed if he
did not make it explicitly clear that he feels that he pursues sound
practices of leadership and management in order to assure the continuity
of the primary mission. Putting it another way, he too recognizes that
a children's hospital measures its profits not in dollars but in children
served.

Joseph P. Greer, Director

"... a children's hospital measures its profits not in
dollars but in children served ..."

"... The plan that created The
Children's Medical Center called
for the gathering together, within
one organization, of all aspects of
Medicine, Surgery and the Labora-
tory Sciences that concern them-
selves with the normal and the sick
infant, child and adolescent ..."

IWM

PLANNING COMMITTEE'S REPORT

The seven Chiefs of Staff of The Children's Hospital Medical Cen-
ter make up the Planning Committee, which in one form or another
reflects a continuity of planning and development going back to 1931.
In that year, Drs. Kenneth Blackfan, William Ladd, Frank Ober, S. Burt
Wolbach, and the present Chairman constituted the Committee. The
present members are Drs. Robert E. Gross, Charles A. Janeway, William
T. Green, George E. Gardner, Edward D. B. Neuhauser, Frank D.
Ingraham, and the Chairman. The Director of the Hospital and the
Director of Development are ex officio members.

All but one of the above named physicians have been active on
the Committee since the expansion of The Children's Hospital into The
Children^ Medical Center in 1947. This title was amended by State
legislation in 1959 to "The Children's Hospital Medical Center," a step
on the part of the Trustees to achieve corporate identity of The Hospital
and the Medical Center and thus move, insofar as feasible, toward closer
integration of the family of institutions listed on the title page of this
Annual Report.

The plan that created The Children's Medical Center called for
the gathering together, within one organization, of all aspects of Medi-
cine, Surgery and the Laboratory Sciences that concern themselves with
the normal and the sick infant, child, and adolescent. The pattern of
centralization, encompassing a flexibility in the manner of merger or
affiliation, has permitted institutions interested in children to join to-
gether and, in so doing, not only create a great medical center but
strengthen themselves. Some developments in this direction have ex-
ceeded all expectations in the dimensions of the programs achieved —
for example, the Judge Baker Guidance Center and The Children's
Cancer Research Foundation. These two institutions and the Children's
Mission to Children, which is concerned with social aspects of child
care, are independent corporations affiliated with The Children's Hos-
pital, the Infants' Hospital, and other units comprising the more unified
administrative structure known as The Children's Hospital Medical
Center.

This C. H. M. C. structure contains the facilities for bed care and
most of the ambulatory services, and it houses the departments of Radi-
ology and Pathology, the Clinical Laboratories, and most of the research
activities of the clinical departments. Harvard Medical School carries
out the major part of its pediatric teaching function in The Children's
Hospital or through the Hospital's affiliates. There are also close rela-
tions — physical, spiritual, and intellectual — with the Peter Bent Brigham
Hospital, which is connected with The Children's Hospital by a bridge
over Shattuck Street. A similar bridge joins the Hospital with The
Children's Cancer Research Foundation, which in turn connects through

a door with The House of the Good Samaritan. The Judge Baker
Guidance Center is joined to the Hospital by a tunnel.

Ten-Year Plan

In 1959, the Planning Committee drew up a development program
for a ten-year period to end in 1969, when the Hospital will celebrate
its Centennial. Only the first three priorities of need will be discussed
in this report.

1. Out-Patient Services. The Planning Committee, in common
with all students of medical care, recognizes that the Out-Patient De-
partment (also known as the Ambulatory Services) represents one of
the C. H. M. C.'s most important contributions to the care of children
in this community, throughout the country, and over the world, the
areas from which our patients come. A steadily changing pattern of
medical care demands experience, skills, and services that are available
only in institutions specially set up to deliver them; the pattern necessi-
tates the provision of better physical arrangements for our Ambulatory "... new physical facilities for out-
Services, together with increases in the numbers of experts in the several patient clinics ..."

clinical divisions of child care, whose services are needed by other doctors
in the care of their patients. Such ambulatory services do not substitute
for home care by the practicing physician, but afford master consul-
tation and specialized types of diagnosis and treatment that no one can
rightfully expect in the office of the most competent private practi-
tioner.

The Planning Committee's recommendation of topmost priority
therefore concerns the building of new physical facilities for out-patient
clinics, so as to provide much better care to a larger number of infants,
children, and adolescents and to extend the horizons of clinical research,
medical education, and postgraduate training.

2. Clinical Research Facilities. Fundamental research in the
sciences basic to medicine, carried on mainly in the Jimmy Fund Building
of The Children's Cancer Research Foundation, has created opportunities
for the several clinical departments to apply new methods, and through
application further expand their efforts, in their own programs of re-
search in diagnosis, treatment, and prevention of children's diseases.
The need for more adequate clinical research facilities, and indeed for
working space of any kind, has become intense. Space is needed both for
laboratories and research beds if programs of clinical investigations are
to be carried on within the Hospital. Plans made more than five years
ago, and since that time further elaborated, call for construction of a
large building housing clinical research facilities and out-patient clinics,
on a site between the present main hospital building (the Farley Building,
formerly known as Building B) and the Longwood Avenue building
(known as Building A) .

These building plans were started long before the "explosion" of

new laboratories for research

clinical investigation in the teaching and research hospitals of the nation.
The initiation of clinical research centers, supported in part by National
Institutes of Health grants of a size never before available, has brought
our hope for a new building much nearer reality.

A clinical research building is needed to bring the contributions
of the basic medical sciences to the patient's bedside. The needs for such
new or expanded facilities are evident in every department and division
of The Children's Hospital Medical Center, including Psychiatry,
Orthopedic Surgery, Cardiology and Cardiovascular Surgery, Pediatric
Medicine, and Pediatric Surgery, and all their subdivisions including
Neurosurgery, Neurology, Radiotherapy, Dental Medicine, Otolaryngol-
ogy, and Ophthalmology, as well as other fields of activity now being
developed at the Center.

The second recommendation of the Planning Committee thus con-
cerns the construction of such a clinical research center without delay.

3. Development of Netv and Specialized Services. In 1960, the

Planning Committee selected Child Neurology as the field of greatest

importance for immediate development. Dr. Bronson Crothers, one of

the great pioneers in this field, began his work (especially concerned with

^^^^ cerebral palsy) more than forty years ago at The Children's Hospital,

and the fine contributions of his successor, Dr. Randolph K. Byers, who
will soon retire, have emphasized the value of a rapid expansion of re-
search and patient care on this major front of Pediatrics. A bene-
factor has provided Harvard Medical School with funds to support a
new Chair in Child Neurology at The Children's Hospital Medical
Center, thus opening the way for the Medical Faculty to seek a man
to lead in the further development of neurological research here. A new
program in Child Neurology cannot proceed at an optimal pace, how-
ever, until facilities both for clinical and basic scientific investigations
have been provided.

The third recommendation of the Planning Committee is for a gen-
eral strengthening in depth of the professional personnel of all depart-
ments and divisions of the C. H. M. C.

A long list of pressing needs in the development of both the clinical
and laboratory approaches to the solution of pediatric problems has been
prepared by the Planning Committee. These will be described in future
reports as the plans are approved by the Trustees.

The work load of the heads of departments and divisions has grown
"... a strengthening in depth of the markedly since the end of World War II, but this growth has not been
professional personnel . . . accompanied by an increase in the number of highly trained men in the

supporting positions. The senior members of the staff have shouldered
greatly increased responsibilities for the care of patients, for teaching,
and for the conduct or supervision of expanding research programs in
the last fifteen years. In addition, they have taken their place in the re-

sponsible governing bodies of voluntary health agencies, private foun-
dations, and, above all, the Federal agencies concerned with medical and
scientific research.

Our original concept of The Children's Medical Center included the
intellectual open door. We have welcomed, and continue to welcome,
physicians and scientists from all over the world who are interested in the
problems of early life, and we have participated, and continue to partici-
pate, in the leadership for the creation and communication of new
knowledge in pediatrics.

The Planning Committee repeatedly has stressed with pride the na-
tional and international adoption of programs in the various phases of
medical research, patient care, and public health as they concern the
child — plans representing multiplications and adaptations of efforts
originally developed at the C. H. M. C.

The objectives of a children's medical center, as discussed, can best be
preserved and perpetuated by strengthening of the staff in terms of solid,
permanent support for more persons in key positions. Such a strengthen-
ing, of course, relates to — and, indeed, is interlocked with — the expan-
sion of the facilities for ambulatory services and for clinical research de-
scribed in the first two recommendations.

The greatest limiting factors in overcoming the deficit in staff have
been, in sum, the lack of space and of money. These factors have been
responsible for loss of key men from our staff, further intensifying the
personnel deficit. Some who left us, we are happy to say, continue to
carry out the broad mission of the C. H. M. C, for they hold positions
of leadership in hospitals and medical schools throughout the United
States and in many other parts of the world.

The Harvard Medical Center

We cannot close this brief review without commenting on the role
of The Children's Hospital Medical Center in the Harvard Medical
Center, particularly taking note of two new programs in the Longwood
Avenue area which, in their fulfillment, will enhance our future in pace
with that of the Medical School, School of Public Health, and the other
teaching hospitals associated with the School.

The Children's Hospital is one of seven associated teaching hospitals
participating with the Medical School in "A Program for Harvard Medi-
cine," a development effort launched in 1960 and aimed primarily at
strengthening the total Medical Faculty. The program calls for the rais-
ing of $5 8,000,000, a portion of which is earmarked for support of the
Hospital's teaching staff. The extent of the C. H. M. C.'s enthusiastic par-
ticipation in the Harvard Medical Center's program may be judged from
the fact that its President, Mr. Wolbach, is Treasurer of "A Program for
Harvard Medicine."

A second program of current interest is the proposed creation of a

"... the Children's Hospital Medical Cen-
ter in the Harvard Medical Center ..."

Harvard "Hospital Complex," an objective most easily visualized in
terms of the creation of one of the "University Hospitals" associated with
the School. The combined hospital proposed would include only a few of
the several members of the Harvard family of teaching hospitals. The
proposal is to construct a hospital complex on property owned by the
Peter Bent Brigham Hospital — the ultimate solution for the space prob-
lems of the Brigham. This plan offers a challenge and an opportunity to
The Children's Hospital Medical Center to join in all activities, where pos-
sible and where feasible, with those hospitals for adults which make up
the complex. The potential gain lies in a combining of administrative
and/or professional services wherever greater efficiency and economy
may be achieved. The Children's Hospital Medical Center has approached
the question of its participation and role in planning the hospital complex
with deep and sympathetic interest. Its Chiefs of Orthopedic Surgery
and of Neurosurgery also head those services in the Brigham, and there
is a long tradition of close and happy cooperation between the two in-
stitutions, and with other members of the proposed complex, such as the
Boston Lying-in Hospital.

Careful study is being given to the possibility of any means of
combining services for the good of the patient. The Planning Com-
mittee emphasizes, however, that when all such studies are finished, there
still will remain an organization devoted primarily to infant, the child,
and the adolescent — The Children's Hospital Medical Center. It is our
belief that we will be most effective in carrying out our own mission by
the pursuit of effective relationships with surrounding institutions. More
explicitly, we believe that in the future, as in the past, our greatest con-
tribution will be made if we continue as a separate group of institutions
identified with child care, but working in the closest possible harmony
and cooperation with the adjacent hospitals for adults, and always within
the magnificent academic setting of the Harvard Medical School, School
of Dental Medicine, and the School of Public Health.

Sidney Farber, M.D., Chairman, Planning Committee

"... There will remain an organization
devoted primarily to infant, child and ado-
lecent ..."

THE CHILDREN'S HOSPITAL MEDICAL CENTER

BOARD OF TRUSTEES

Adams, Charles F.

Aldcn, Vernon R.

Almy, Mrs. Robert B.

Andrews, Kent

Anthony, Julian D.

Ayer, Neil R.

Badger, Shcrwin C.

Bartlett, Nelson S., Jr.

Bartlett, Mrs. Nelson S.

Batchelder, Mrs. Charles F., Jr.

Berman, Matthew

Bower, Albert B.

Bronstein, Philip G.

Brooks, John G.

Buttrick, Stedman

Cabot, Thomas D.

Cooper, John L.

Crocker, Frank W.

Damon, Roger C.

Dane, Walter A.

Duane, J. Marshall

Erickson, Joseph A.

Estin, Hans H.

Falvey, Donald

Farley, Mrs. J. W.

Flood, Richard R.

Forbes, F. Murray

Forbes, F. Murray, Jr.

Francis, Mrs. Edward L.

Friend, Mrs. Archer D.

Friend, Mrs. Dale

Fuess, Dr. Claude M.

Fuller, Mrs. Robert G.

Gardner, G. Peabody

Gardner, George P., Jr.

Gardner, Harrison

Gardner, John L.

Glcason, Francis H.

Grccnbaum, Joseph

Hallowell, Robert H.

Hansel, Lawrence H.

Harwood, Bartlett

Hayes, Miss Helen

Hellmuth, Paul F.

1 lood, I [arvey P.

Hopkins, Mrs. Robert H.

Hovey, Mrs. Charles F.

Howe, P. 1).

Howland, Weston, Jr.

Hunncwell, Arnold W.

Isaacs, Kenneth I..

Jenney, Reginald

Johnson, Edward C, 2nd

Kahn, Milton

John F, Kennedy,

President of the United States
Knight, Richard C.
Ko/ol, Irank L.

Kulp, Benjamin
Laughlin, Henry A.
Lewis, Arthur L.
Livermore, Robert J.
Lockwood, Arthur H.
Lowe, John W.
Manice, William D., Jr.
Mason, Austin B.
Mittell, David A.
Mitton, Edward R.
Moir, Mrs. John A.
Morton, William F.
Mumford, George S., Jr.
Neal, Mrs. Kirke A.
Nordblom, Robert C.
O'Keeffe, Adrian
Pappas, Thomas A.
Peabody, Miss Amelia
Perkins, Mrs. James H.
Perry, Edgar A.
Perry, Mrs. Roger A.
Prouty, Mrs. Lewis I.
Rabb, Norman S.
Revere, Miss Margaret A.
Ripley, Walter J., Jr.
Rose, Edward
Ross, Thorvald S.
Rotch, Arthur G.
Semenenko, Serge
Sidd, Samuel
Silverman, William A.
Slosberg, Samuel L.
Spencer, Mrs. Charles E., Jr.
Stockemcr, George A.
Swift, William N.
Turner, Mrs. Howard M.
Turner, James S.
Warren, Howland S.
Wheeler, Alexander
Wheeler, Mrs. Alexander
Wheeler, Mrs. Henry, Jr.
White, Henry K.
Whiteside, Alexander
Wilder, Mrs. David
Williams, Ben Ames
Wing, Mrs. Raymond
Wolbach, William W.

CORPORATION MEMBERS

THE CHILDREN'S HOSPITAL MEDICAL CENTER

Abbott, Gordon
Anderson, L. Clayton
Bain, Sherwood E.
Beal, Mrs. William DeFord
Berenson, Richard A.
Bond, David S.
Brewster, George W. W.
Brigham, F. Gorham, Jr.
Brin, Dr. Alexander
Brooks, Francis H.
Brooks, Mrs. Paul
Brown, William L.
Callahan, Raymond J.
Catlin, Ephron, Jr.
Clapp, Mrs. Eugene H., II
Clapp, Joseph A., Jr.
Coburn, Miss Louise
Comerford, Richard, Hon.
Coolidge, Mrs. T. Jefferson
Crosby, W. Edgar, Jr.
Darling, Nelson J.
Devens, Charles
Dik, Willard Blake
Dorr, Richard G.
Everts, Albert P., Jr.
Febiger, Mrs. William S.
Fitzgerald, Miss Adelaide
Fitzgerald, James F.
Flint, John G.
Forbes, Mrs. F. Murray, Jr.
Fulton, A. Oram, Jr.
Gardner, Mrs. John L.
Goodrich, John W.
Gray, Roland, Jr.
Hansel, Mrs. Lawrence H.
Harding, Francis A.
Hatch, Francis W., Jr.
Hawkins, Mrs. Frederick D.
Hollingsworth, Amor, Jr.
Hopkins, Mrs. Edward B.
Hovey, Chandler
Hovey, Charles F.
Howe, Henry S.
Howe, Mrs. Parkman D.
Hunnewell, James F.
Jackson, Charles
Jackson, James, Jr.
Kiley, Mrs. John C, Jr.
Kiley, John C.
Kimball, Frederick M.
King, John S.
Kirk, John M.
Klotz, Harry J.
Ladd, C. Haven
Lanman, Mrs. Thomas H.
Lawrence, Mrs. John E.
Lecn, Henry M.
Lerman, Paul

Lovejoy, George M., Jr.
Low, Dr. Merritt B.
Luce, Stephen C, Jr.
Lyne, Daniel J., Jr.
Macomber, C. Clark
Markson, Robert T.
Marzynski, Mrs. Julian A.
McDevitt, Daniel J.
Mcintosh, Harry R.
Merriam, Mrs. Robert C.
Minot, James J.
Mock, Harold A.
Moir, John A.
Moody, Burt R.
Morrissey, Francis X., Hon.
Morrissey, Major Nicholas P.
Murphy, Edward
Newhall, Charles B.
Newman, Stanley O.
Niles, Harold L.
Olmsted, George, Jr.
Olmsted, J. Warren
Parker, William A.
Pease, Robert G.
Perini, Louis R.
Piper, Mrs. Richard F.
Pitcher, Mrs. Robert B.
Potter, Cary
Pratt, Mrs. W. Elliott
Precourt, Harry A.
Preston, Richard
Prouty, Richard
Rice, Edmund
Robie, Richard S.
Rockett, Miss Emily
Rosen, Gerald
Rudd, Edward G.
Shapiro, George
Smith, Dr. Richard M.
Smith, Sam
Snow, William B.
Southworth, W. Brewster
Spence, W. Frederick
Spring, John K.
Stanbro, D. B.
Stanwood, Geoffrey R.
Stayman, Mrs. Bennett H.
Steffian, Edwin T.
Stockton, Charles H.
Stockwell, Ernest F., Jr.
Stone, Robert Gregg
Sturgis, Edward, Jr.
Sulloway, Frank J.
Swift, Humphrey H.
Tew, Mrs. John B.
Thayer, Mrs. Sherman R.
Thompson, George E., Flon.
Tufts, John S.

Tyler, Daniel, Jr.
Tyler, Linscott
Wallace, Mrs. Jacob
Webster, Mrs. Edwin S.
Weeks, Edward A., Jr.
West, Richard S.
Whalen, James V.
Wheatland, Stephen
Wheeler, Alexander, Jr.
Wheeler, James G.
White, Loren C.
Whiteside, Howard S.
Whitman, Mrs. Nehemiah H.
Wilson, John J.
Wolcott, Mrs. Samuel H., Jr.
Wyman, Richard M.

THE CHILDREN'S HOSPITAL MEDICAL CENTER STAFF 1960 - 1961

DEPARTMENT OF MEDICINE

PHYSICIAN-IN-CHIEF

Charles A. Janeway, M.D.

ASSOCIATE CHIEF

OF THE MEDICAL SERVICE

Louis K. Diamond, M.D.

General Medical Divisions
Child Health Division

Robert J. Haggerty, M.D.

Medical Out-Patient Department

Charles D. Cook, M.D.

Adolescent Division

J. Roswell Gallagher, M.D.

Newborn Division

Stewart H. Clifford, M.D.

Infants' and Children's
Medical Division

William Berenberg, M.D.

Private Medical Division

John A. V. Davies, M.D.

PHYSICIANS

William Berenberg, M. D.
Stewart H. Clifford, M.D.
Charles D. Cook, M.D.
John A. V. Davies, M.D.
R. Cannon Elcy, M.D.
Henry E. Gallup, M.D.
Robert J. Haggerty, M.D.
Alexander S. Nadas, M.D.
David D. Rutstein, M.D.
David W. Sherwood, M.D.
Harry Shwachman, M.D.
Clement A. Smith, M.D.

ASSOCIATE PHYSICIANS

Olga E. Allen, M.D.
John K. Brines, M.D.

John F. Crigler, Jr., M.D.

Allen C. Crocker, M.D.

James E. Drorbaugh, M.D.

F.dward C. Dyer, M.D.

Francis X. Fellers, M.D.

Albert A. Frank, M.D.

Park S. Gerald, M.D.

David Gitlin, MIX

Robert D. Gricsemcr, M.D. (m r.matoi.ogy)

medicine continued

Sprague W. Hazard, M.D.

Allen M. Hill, M.D.

John P. Hubbell, Jr., M.D.

Samuel L. Katz, M.D.

Sidney Kibrick, M.D.

Robert T. Moulton, M.D.

Maurice M. Osborne, M.D. to 7/31/60

Richmond S. Paine, M.D.

Murray Ethan Pendleton, M.D.

William Pfeffer, M.D.

Gertrud C. Reyersbach, M.D.

Edward Manning Sears, M.D.

Leonid S. Snegireff, M.D.

William J. Turtle, M.D.

John W. G. Tuthill, M.D.

William D. Winter, M.D.

ASSISTANT PHYSICIANS

Donald M. Allen, M.D.

Euan T. Blanch, M.D.

T. Berry Brazelton, M.D.

William D. Cochran, M.D.

Albert Cohen, M.D.

Kelley K. Davis, M.D.

Karel deHaas, M.D.

William A. Dickson, M.D.

Elaine K. Donnellan, M.D.

William R. Dorsey, M.D.

Audrey E. Evans, M.D.

Stephen M. Frawley, M.D.

Sidney Green, M.D.

Mildred Jefferson, M.D.

Maurice N. Kay, M.D.

Charles S. Keuper, M.D. (dermatology)

Leon E. Kruger, M.D.

Lucas L. Kulczycki, M.D.

Alexander S. MacDonald, M.D.

Campbell W. MacMillan, M.D.

D. Hugh MacNamee, M.D.

Lillian A. F. McMackin, M.D.

Anna Mitus, M.D.

Alice Nauen, M.D.

Robert J. Orme, M.D.

Joseph Osborne, M.D.

Julian Pcarlman, M.D.

Thomas C. Peebles, M.D.

Howard J. Potter, M.D.

Henry M. Putnam, M.D.

John S. Robey, M.D.

Herbert L. Ruben, M.D.

Arthur J. Salisbury, M.D.

James R. Sayre, M.D.

Robert T. Scccry, M.D.

Nasrollah T. Shahidi, M.D.

Gerald B. Shattuck, M.D.

Samuel Norman Sherry, M.D.

medicine continued

Allan E. Stimson, M.D.
George H. Taft, M.D.
Richard H. Watson, M.D.
Harold J. Wheeler, M.D.

RESEARCH ASSOCIATES IN MEDICINE

Norman I. Gold, Ph.D.
Ezio Merler, Ph.D.

CLINICAL RESEARCH ASSOCIATE
IN MEDICINE

Miriam D. Manning, M.D. (tumor therapy)

Adolescent Division

CHIEF

J. Roswell Gallagher, M.D.

ASSOCIATE PHYSICIANS

C. Cabell Bailey, M.D.
Richard S. Eustis, M.D.
Dana L. Farnsworth, M.D.
Robert P. Masland, M.D.
Walter W. Point, M.D.
John A. Spargo, M. D.

ASSISTANT PHYSICIANS

Charles S. Gleason, M.D.
Andrew D. Guthrie, M.D.
Thomas J. Murphy, M.D.
Frederick A. Pierce, Jr., M.D.

RESEARCH ASSOCIATE

Carl Seltzer, Ph.D.

Child Health Division
CHIEF

Robert J. Haggerty, M.D.

ASSOCIATE PHYSICIANS

Ralph A. Ross, M.D.
Abraham S. Small, M.D.
Lcndon Sncdeker, M.D.
Leon Stcrnfeld, M.D.
Pauline G. Stitt, M.D.

ASSISTANT PHYSICIANS

Roger J. Meyer, M.D.

Hcdwig Elizabeth Rose (Orncr), M.D.

Eva J. Salbcr, M.D.

Isabcllc Valadian, M.D.

medicine continued

Special Medical Divisions

Allergy Division

ALLERGIST

Harry L. Mueller, M.D.

ASSISTANT ALLERGIST

Irving W. Bailit, M.D.

ASSISTANT PHYSICIANS

Theodore Bennett, M.D.
Frederick Blumenthal, M.D.
George T. Critz, M.D.
Elizabeth A. Gregory, M.D.
Lawrence S. Morse, M.D.
Otto S. Nau, M.D.

Cardiology Division

CARDIOLOGIST

Alexander S. Nadas, M.D.

ASSOCIATE CARDIOLOGISTS

Walter T. Goodale, M.D.
Anna J. Hauck, M.D.
Benedict F. Massell, M.D.

ASSISTANT CARDIOLOGISTS

Albert Cohen, M.D.
Joseph G. Cutler, M.D.
Allen L. Friedlich, M.D.
R. Greer Monroe, M.D.
Jacob Wallace, M.D.
Richard J. Waters, M.D.
Richard Wolff, M.D.
Alia Gergory Zaver, M.D.

Good Samaritan Division

CHIEF

Charles A. Janeway, M.D.

PHYSICIANS

Edward F. Bland, M.D.
Gabor Czoniczer, M.D.
Allen L. Friedlich, M.D.
Sprague W. Hazard, M.D.
Benedict F. Massell, M.D.
Sylvester McGinn, M.D.
Alexander S. Nadas, M.D.
Marian W. Ropes, M.D.
David D. Rutstcin, M.D.
George P. Sturgis, M.D.
Edwin O. Wheeler, M.D.
Conger Williams, M.D.

medicine continued

ASSISTANT PHYSICIAN

Teogenes Carbonilla, M.D.

Hematology Division

HEMATOLOGIST

Louis K. Diamond, M.D.

ASSOCIATE HEMATOLOGIST

Fred H. Allen, M.D.

ASSISTANT HEMATOLOGISTS

Donald M. Allen, M.D.
Park S. Gerald, M.D.

RESEARCH ASSOCIATE

Mary Louise Efron, M.D.

Neurology Division

NEUROLOGIST

Randolph K. Byers, M.D.

ASSOCIATE NEUROLOGIST

Richmond S. Paine, M.D.

ASSISTANT NEUROLOGIST

Simeon Locke, M.D.

Seizure Unit

ASSOCIATE NEUROLOGIST

Cesare Lombroso, M.D.

Director of
Postgraduate Education

R. Cannon Eley, M.D.

DEPARTMENT OF PSYCHIATRY

PSYCHIATRIST-IN-CHIEF

George E. Gardner, Ph.D., M.D.

PSYCHIATRISTS

Tully Benaron, M.D.
Lydia Dawes, M.D.
Henry Wermer, M.D.

ASSOCIATE PSYCHIATRIST

Herbert I. Harris, M.D.

ASSISTANT PSYCHIATRISTS

children's hospital

Graham Burt Blaine, M.D.
John R. Blitzer, M.D.
Dorothy M. Bollinger, M.D.
Lawrence Claman, M.D.
William M. Crowell, M.D.
Chester C. D'Autremont, M.D.
Hilda Effgen, M.D.
Richard Galdston, M.D.
Marvin Krims, M.D.
William Earl Stone, M.D.
Harold Wolman, M.D.

JUDGE BAKER

Ann Brown, M.D.

John C. Coolidge, M.D.

Richard Emerson, M.D.

Alice Fleming, M.D.

Thomas Frank, M.D.

Dorothy Macnaughton, M.D.

Elizabeth Makkay, M.D.

Vera Tisza, M.D.

Stanley Walzer, M.D. (as of 5>/l/60)

John Weil, M.D.

Lee M. Wilier, M.D.

Bernard D. Woods, M.D.

Joan Zilbach, M.D.

PSYCHOLOGISTS

children's hospital

Joseph P. Lord, Ph.D., Chief

Arnold Bookspun, M.A.

Haskel Cohen, Ph.D.

Miriam Fiedler, Ph.D.

Margaret Ingram, M.A.

Emma Kraidman, Ph.D.

Sara Lee Moltz, M.A.

Gcraldine Rickard, Ed.D.

Celia Schulhoff, M.A. (as of 9/l/60)

Edith Meyer Taylor, Ph.D.

Albert Tricschman, Ph.D.

Charles Woodbury, Ph.D.

continued

psychiatry continued

JUDGE BAKER

Bessie Sperry, Ph.D., Chief

Pauline Hahn, Ph.D., Research Director

Laura Heims, Ph.D.

Irving Hurwicz, Ph.D.

Arne Korstvedt, M.A.

Norman Prentice, Ph.D.

Edleff Schwaab, Ph.D.

Ellen Tessman, Ph.D.

Nicholas Verven, Ph.D.

Samuel Waldfogel, Ph.D.

Robert Young, Ed.D.

RESEARCH ASSOCIATES

Sidney Croog, Ph.D.
Eric Lenneberg, Ph.D.
Barbara K. Sutherland, Ph.D.
Peter Wolff, M.D.

DEPARTMENT OF SURGERY

SURGEON-IN-CHIEF

Robert E. Gross, M.D.

SURGEONS

Luther A. Longino, M.D.
Donald W. MacCollum, M.D.
Samuel R. Schuster, M.D.
George W. B. Starkey, Jr., M.D.

ASSOCIATE SURGEONS

Thomas W. Botsford, M.D.
John W. Chamberlain, M.D.
Chilton Crane, M.D.
Henry W. Hudson, Jr., M.D.

ASSISTANT SURGEON

W. Hardy Hendren, III, M.D.

Anesthesia Division

ANESTHESIOLOGIST

Robert M. Smith, M.D.

ASSOCIATE ANESTHESIOLOGISTS

Mary Psaltopoulo, M.D.
Anibal Salazar, M.D.
John Stetson, M.D.

DEPARTMENT OF
OPHTHALMOLOGY

OPHTHALMOLOGIST-IN-CHIEF

Trygve Gundersen, M.D.

ASSOCIATE OPHTHALMOLOGISTS

Sumner D. Liebman, M.D.
S. Forrest Martin, M.D.

ASSISTANT OPHTHALMOLOGISTS

Arthur F. Calnan, M.D.
Alfred W. Scott, M.D.

DEPARTMENT
OF DENTISTRY

DENTIST-IN-CHIEF

Paul K. Losch, D.D.S.

PEDODONTIST

Charles L. Boycrs, D.M.D.

ORTHODONTISTS

Mclvin I. Cohen, D.M.D.
LennarJ T. Swanson, D.M.D.

ASSISTANT PEDODONTIST

Terrence D. Hoover, D.M.D.

DEPARTMENT OF
OTOLARYNGOLOGY

OTOLARYNGOLOGIST-IN-CHIEF

Carlylc G. Flake, M.D.

OTOLARYNGOLOGIST

Charles F. Ferguson, M.D.

ASSOCIATE OTOLARYNGOLOGIST
(CHIEF E.N.T. OPD)

John C. Trakas, M.D.

Cleft Palate Dental Clinic

ASSOCIATE ORTHODONTIST

Edward I. Silver, D.M.D.

ASSISTANT ORTHODONTISTS

Henry C. Beebe, D.D.S.
Emory Farrington, D.M.D.
Abijah Pierce, D.M.D.

Hearing and Speech Clinic

DIRECTOR

Adam J. Sortini, Ed.D.

DEPARTMENT OF
ORTHOPEDIC SURGERY

ORTHOPEDIC SURGEON-IN-CHIEF

William T. Green, M.D.

ORTHOPEDIC SURGEONS

Jonathan Cohen, M.D.
William A. Elliston, M.D.
Paul W. Hugenbcrger, M.D.
Arthur W. Trott, M.D.

ASSOCIATE ORTHOPEDIC SURGEON

Henry H. Banks, M.D.

ASSISTANT ORTHOPEDIC SURGEONS

Frank D. Bates, M.D.
Paul P. Griffin, M.D.
John G. Kuhns, M.D.
Mihran O. Tachdjian, M.D.

JUNIOR ASSISTANT
ORTHOPEDIC SURGEON

Alan Weiner, M.D.

DEPARTMENT OF RADIOLOGY

RADIOLOGIST-IN-CHIEF
E. B. D. Neuhauser, M.D.

RADIOLOGIST

Martin Wittenborg, M.D.

ASSOCIATE RADIOLOGIST
(RADIOTHERAPY)

Guilio J. D'Angio, M.D.

ASSOCIATE RADIOLOGIST

G. B. C. Harris, M.D.

DEPARTMENT OF
NEUROSURGERY

NEUROSURGEON-IN-CHIEF

Franc D. Ingraham, M.D.

NEUROSURGEON

Donald D. Matson, M.D.

ASSOCIATE NEUROSURGEON

Edgar A. Bering, Jr., M.D.

ASSISTANT NEUROSURGEON

John Shillito, M.D.

DIVISION OF LABORATORIES
AND RESEARCH

CHAIRMAN

Sidney Farber, M.D.

Department of Pathology

PATHOLOGIST-IN-CHIEF

Sidney Farber, M.D.

PATHOLOGIST

Gordon F. Vawter, M.D.

ASSOCIATE PATHOLOGISTS

Betty Q. Banker, M.D. (Neurology)
Jonathan Cohen, M.D. (Orthopedics)

RESEARCH ASSOCIATES

Richard A. Adams, Ph.D.

Rogelio A. Alarcon, Ph.D.

Sherman Beychok, Ph.D.

Stanley M. Bloom, Ph.D.

Elkan R. Blout, Ph.D.

Ornella Calabi, Sc.D.

Giuliana Cardinali, D.Sc.

Giuseppe Cardinali, M.D.

Donald L. D. Caspar, Ph.D.

Suprabhat Chatterjee, Ph.D.

Elizabeth F. Claflin, Ph.D.

Carolyn Cohen, Ph.D.

J. LeRoy Conel, Ph.D.

Allen C. Crocker, M.D.

Isaac Djerassi, M.D. (until 7/31/60)

Samuel S. Epstein, M.D.

Gerald D. Fasman, Ph.D.

Shou-Cheng J. Fu, Ph.D.

Alfred H. Handler, Ph.D.

Kenneth C. Holmes, Ph.D.

Mervyn Israel, Ph.D.

Lawrence Kingsland, M.D. (biometrics)

Edmund Klein, M.D.

Ramchandra K. Kulkarni, Ph.D.

Livia Hedvig Rev Kury, M.D.

Cecilie Leuchtenberger, Ph.D.

Rudolf Leuchtenberger, M.D.

Arlene C. Longwell, Ph.D.

Susan Lowey, Ph.D.

Robert E. McCarthy, Ph.D.

Charlotte L. Maddock, M.D.

Edward J. Modest, Ph.D.

Marion F. Narrod, Ph.D.

Carl R. Partanen, Ph.D.

Elizabeth R. Simons, Ph.D.

Kyoko Tanaka, Sc.D.

Tatsuya Tanaka, Sc.D.

Betty G. Uzman, M.D.

Donald B. Wetlaufcr, Ph.D.

Laurens P. White, M.D.

George Yerganian, Ph.D.

laboratories and research continued

RESEARCH ASSISTANTS

Virginia Binns, Sc.B.
Christianne T. DeLoze, Sc.D.
Beatrice P. Drolet, Sc.B.

Laboratory of Clinical Pathology
CHIEF

Harry Shwachman, M.D.

BACTERIOLOGIST

George E. Foley, Sc.D.

RESEARCH ASSOCIATES

Irena Antonowicz, M.Sc.
John T. Clarke, Ph.D.
Morris N. Green, Ph.D.

RESEARCH ASSISTANT

Eva Fekete, M.D.*

Research Division

of Infectious Diseases

CHIEF

John F. Enders, Ph.D.

RESEARCH ASSOCIATES

Samuel L. Katz, M.D.
Sidney Kibrick, M.D.

Tumor Therapy Division

PHYSICIANS

William Berenberg, M.D. (See Medicine)

Audrey E. Evans, M.D.

Harry Shwachman, M.D. (See Medicine)

Leonid S. Snegireff, M.D.

Laurens P. White, M.D.

ASSISTANT PHYSICIANS

Mildred F. Jefferson, M.D. (to 12/31/60)
Anna Mitus, M.D.

RADIOTHERAPIST

Giulio J. D'Angio, M.D. (See Radiology)

CLINICAL RESEARCH ASSOCIATE
IN MEDICINE

Miriam D. Manning, M.D.

'Deceased

CONSULTANTS

EMERITI

MEDICINE

Benjamin Alexander, M.D.

COMPARATIVE PATHOLOGY

Donald L. Augustine, M.D.

DENTISTRY

Harry K. Bailey, D.M.D.

ORTHOPEDIC SURGERY

Joseph S. Barr, M.D.

UROLOGY

Hathorn P. Brown, M.D.

OPHTHALMOLOGY

Paul A. Chandler, M.D.

DERMATOLOGY

Austin W. Cheever, M.D.

NEUROLOGY

Stanley Cobb, M.D.

OPHTHALMOLOGY

David G. Cogan, M.D.

PATHOLOGY

Gustave E. Dammin, M.D.

MICROBIOLOGY

Bernard D. Davis, M.D.

PSYCHIATRY

Felix Deutsch, M.D.

MEDICINE

Lewis Dexter, M.D.

OPHTHALMOLOGY

Edwin B. Dunphy, M.D.

MEDICINE

Kendall Emerson, M.D.

PHYSIOLOGY

Benjamin G. Ferris, M.D.

ANESTHESIOLOGY

Jacob Fine, M.D.

MEDICINE

Sydney S. Gellis, M.D.

UROLOGY

J. Hartwell Harrison, M.D.

pa mm OGY

Arthur Hertig, M.D.

DERMA TOLOGY

William R. Hill, M.D.

PA I IIOI.OCY

Oscar Hirscli, M.D.

AN I HROPOl (X.Y

William W. Howells, Ph.D.

OR i HOPEDIC SURGERY

Meier S. K.irp, M.D.

INI I ( i iocs DIS1 ase
Edward Kiss, M.D.
[>i n ; I ISIRY
Owen W. Kile, D.M.D.

PHARMACOLOGY

Otto Krayer, M.D.

PHYSIOLOGY

Eugene M. Landis, M.D.

EDUCATION

Edward Landy, Ed.D.

MEDICINE

Samuel A. Levine, M.D.

RADIOLOGY

Joseph Marks, M.D.

NUTRITION

Jean Mayer, Ph.D., D.Sc.

PATHOLOGY

William Meissner, M.D.

SURGERY

Francis D. Moore, M.D.

OBSTETRICS

Duncan Reid, M.D.

CHILD HEALTH

William M. Schmidt, M.D.
Herbert Selenkow, M.D.

OPHTHALMOLOGY

Albert E. Sloane, M.D.

RADIOLOGY

Magnus Smcdal, M.D.

NUCLEAR MEDICINE

Arthur Solomon, M.D.

GYNECOLOGY

Somers H. Sturgis, M.D.

PREVENTIVE MEDICINE

Carl E. Taylor, M.D.

NEOPLASTIC DISEASES

Grantley Taylor, M.D.

MEDICINE

George W. Thorn, M.D.

SURGERY

Carl W. Walter, M.D.

PATHOLOGY

Shields Warren, M.D.

INFECTIOUS DISEASES
Louis Wcinstcin, M.D.

STOMATOLOGY

David Wcisbcrger, M.D.

PARASITIC AND VIRAL DISEASES

Thomas H. Wellcr, M.D.

PHYSIOLOGY

James L. Whittenberger, M.D.

Nl UROPA1 HOLOGY
Paul Yakovlcv, M.D.

ORTHOPEDIC SURGEON, EMERITUS

Albert H. Brewster, M.D.

CONSULTANT IN MEDICINE, EMERITUS

C. Sidney Burwell, M.D.

CONSULTANT IN MEDICINE, EMERITUS

Allan M. Butler, M.D.

CONSULTANT IN CHILD HEALTH, EMERITUS

Martha M. Eliot, M.D.

CONSULTANT IN RADIOLOGY, EMERITUS

Albert Ferguson, M.D.

PHYSICIAN, EMERITUS AND ALLERGIST, EMERITUS

Lewis W. Hill, M.D.

PHYSICIAN, EMERITUS

Eliot Hubbard, Jr., M.D.

SURGEON-IN-CHIEF, EMERITUS

William E. Ladd, M.D.

SURGEON, EMERITUS

Thomas H. Lanman, M.D.*

ORTHOPEDIC SURGEON, EMERITUS

Robert H. Morris, M.D.

CONSULTANT IN SURGERY, EMERITUS

Charles G. Mixter, M.D.

CONSULTANT IN SURGERY, EMERITUS

Francis C. Newton, M.D.

ORTHOPEDIC SURGEON-IN-CHIEF

Frank R. Ober, M.D.*

CONSULTANT IN OTOLARYNGOLOGY, EMERITUS

Leroy A. Schall, M.D.

ORTHOPEDIC SURGEON, EMERITUS

James W. Sever, M.D.

PHYSICIAN-IN-CHIEF, EMERITUS

Richard M. Smith, M.D.

CONSULTANT IN CHILD HEALTH, EMERITUS

Harold C. Stuart, M.D.

CONSULTANT IN OPHTHALMOLOGY, EMERITUS

Frederick A. VcrhoerT, M.D.

CONSULTANT IN INFECTIOUS DISEASES, EMERITUS

Conrad Wesselhoeft, M.D.

PHYSICIAN, EMERITUS

Edwin T. Wyman, M.D.
* Deceased.

^ *J

**-

W^al

>*i

£ _

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

In Memoriam 43

Report of Physician-in-Chief 45

Report of Surgeon-in-Chief 59

Report of Anesthesiologist 62

Report of Orthopedic Surgeon-in-Chief 65

Report of Neurosurgeon-in-Chief 73

Report of Psychiatrist-in-Chief 79

Report of Radiologist-in-Chief 89

Division of Laboratories and Research 93

Department of Otolaryngology 113
Department of Dentistry 115

Department of Ophthalmology 116

IN MEMORIAM

On December 25, 1959, Dr. J. Lewis Bremer, embryologist, who
worked in the Pathology Department for eighteen years, died at the age
of eighty-five.

On July 21, 1960, Dr. William G. Lennox died. Dr. Lennox, who
was seventy-six years old, was the founder of our Seizure Unit and a
pioneer in the study of epilepsy and the crusade for social enlightenment
regarding victims of this disease. Further comment may be found in the
Physician-in-Chief's report.

On October 4, 1960, Dr. David S. Grice was killed in an airplane
accident at Logan Airport. Dr. Grice, who was forty-six years old, came
to The Children's Hospital for training and was a member of the staff
from 1944 to 1958, when he left to accept the appointment of Professor
of Orthopedic Surgery at the University of Pennsylvania. His friends
and former patients have contributed approximately $8,000 for a Grice
Memorial Fund at The Children's Hospital.

On December 26, 1960, Dr. Frank Ober died at the age of seventy-
nine, after a brief illness. Orthopedic Surgeon-in-Chief for fifteen years
prior to his retirement in 1946, Dr. Ober was a member of The Chil-
dren's Hospital staff from 1913 until his death. A clinical Professor of
Orthopedic Surgery at Harvard Medical School and former Assistant
Dean, he established the Frank Ober Orthopedic Research Fund at this
Hospital in 1941.

DEPARTMENT OF MEDICINE

REPORT OF
PHYSICIAN-IN-CHIEF

SERVICES TO PATIENTS

The significant changes in the charac-
ter and volume of the Center's services
to children are nowhere revealed more
plainly than in a comparison of the
operations of the Medical Department
in the year ending September 30,
I960, with its operations in previous
years. A study of the table on page 46,
showing the estimated volume of serv-
ices in the current year, discloses strik-
ing differences, and impressive growth
and suggests the existence of definite
needs. Certain trends are unmistak-
able. Out-patient or Ambulatory Serv-
ices have grown strikingly in volume,
by 72 per cent since 1946-47, by 36
per cent over the past four years. This
growth of ambulatory services reflects
three processes of change: (a) the
development of new services, such as
the Child Health Unit and the Adoles-
cent Unit; (b) an extraordinary ex-
pansion in the activities of the Medical
Emergency Clinic, which has become
the largest medical clinic; and (c) an
increase in the case load of certain
special clinics, particularly the Cardiac
Clinic. While this growth has oc-
curred, there has been a decline in the
activity of the general Medical Out-
patient Clinic, which mainly reflects
the development of adequate facilities
and staff for the management of acute
illness in the Medical Emergency
Clinic.

Over the same period, there have
been equally important changes in the
volume and character of our In-patient
Services. While this number of admis-
sions to the acute services has risen by
32 per cent since 1946-47, the number
of hospital days of care has declined
by 46 per cent, a trend which is re-
flected in a much shorter average
length of stay of 34 per cent. For all
medical in-patient services over the
past thirteen years, the number of ad-

missions has risen by 29 per cent, and
the number of hospital days has de-
clined by 45 per cent. All this shows
why we have been able to care for
more children in the hospital with
fewer medical beds, and also why, with
a high turnover of sick patients, more
personnel are needed and costs have
risen. These changes presumably re-
flect better medical care and a higher
standard of living in the community,
population trends, and improved meth-
ods of treatment in the hospital. It is
interesting that hospital admissions
have been rising despite virtual elim-
ination of poliomyelitis as a major dis-
ease requiring hospital care. However,
it seems likely that the trend of rising
admissions will continue only if we
draw from an increasingly large popu-
lation base or provide more extensive
services to the low-income groups
moving into the city from the South
and from Puerto Rico. The incidence
of disease is high among such groups
because of poor socio-economic con-
ditions.

On the medical services last year
there were 159 deaths. Although the
Medical Services care for children of
all ages up to twenty years, 59 per cent
of all deaths occurred in newborn in-
fants and 78 per cent in newborns and
infants under three years. These fig-
ures emphasize the well-known fact
that the bulk of childhood mortality is
in infancy and particularly in the first
month of life, and that its principal
causes are congenital malformations,
particularly of the heart, and perinatal
disease.

The Medical Service as a whole may
be thought of as a large and complex
pediatric practice, the services being
given by a large group rather than by
a single physician. It includes, in dif-
ferent proportions to be sure, all the
functions of a practicing physician, as
follows :

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Health supervision of children and
home visits to sick children. These
two prime functions of the prac-
ticing physician are provided to a
selected group of families through the
Child Health Unit and its Family Care
Program, not because such services are
lacking in the community but because
they offer invaluable experience for
education of the future physician and
provide a small pediatric practice
within which research upon many as-
pects of family medicine can be car-
ried on.

Twenty-four-hour emergency service.
The Medical Emergency Clinic pro-
vides this service. Closely integrated
with it is the Poison Information Cen-
ter, which provides information for
physicians and parents upon the in-
gredients, toxicity, and recommended
treatment for any chemical substance
ingested accidentally by a child.

Hospitalization for illness. The In-
patient Service provides this care.
Consultation for less acute illness.
This major service is available on ap-
pointment for children up to twelve
years of age in the Medical Out-
patient Department and for children
over twelve years in the Adolescent
Unit, and occasionally by admission to
the wards for study.
Long-term medical supervision and re-
habilitation of children with chronic
illnesses. These services are primarily
the function of the various special clin-
ics staffed by the same group of doctors.
Regular attendance at a special clinic
with particular knowledge of the dis-
ease provides the continuity in care
and in doctor-patient relationship
which is so important in treating chil-
dren with chronic disease. Usually
the day by day medical care of the
child is provided by the family physi-

cian, the long-term management of
disease being directed by the Hospital
Staff.

These last four are essential serv-
ices filling a very real need. In a sense,
The Children's Medical Center func-
tions as three hospitals in one: as a
community hospital serving the gen-
eral medical needs of a considerable
group of children in the Greater Bos-
ton area; as a regional hospital pro-
viding consultation service for physi-
cians and community hospitals in the
New England area; and a final court
of appeal for distraught families who
may come for help with a sick child
from anywhere in the world. These
last two functions are what make The
Children's Hospital Medical Center a
unique institution. They depend pri-
marily on the extraordinary diversity
of talent, on the tremendous experi-
ence of the staff and on the unique

VOLUME OF SERVICES

OUT-PATIENT SERVICES

Per cent <

:hange since

(Total Visits)

1946-47

1951-52

1956-57

1957-58

1958-59

1959-60*

1946-47

1956-57

ALL MEDICAL CLINICS

24,360

24,425

30,939

31,156

38,622

(41,977)

+72%

+36%

Child Health Unit

2,839

2,146

3,105

(3,081)

—

Medical Emergency

4,798

5,506

5,422

12,274

(14,450)

—

General Medical OPD

13,470

7,922

7,701

6,595

6,693

(6,322)

—

Adolescent Unit

600

4,827

5,116

5,249

(5,897)

—

Special Clinics

10,890

11,705

10,057

10,991

11,901

(12,227)

—

IN-PATIENT SERVICES

Acute Services

Admissions

2,261

3,326

2,917

2,818

3,417

(3,312)

+32%

+ 12%

Hospital Days

33,926

29,039

26,484

27,189

27,834

(26,796)

—21%

+ 1%

Average Stay (Days)

8.7

8.4

9.6

8.1

(8.1)

—46%

— 3%

Chronic Services

Admissions

464

443

253

189

208

(218)

—53%

—13%

Hospital Days

32,692

29,682

20,757

13,451

10,189

(10,111)

—70%

—50%

Average Stay (Days)

(46)

—34%

—AA%

TOTAL IN-PATIENT

Admissions

2,725

3,769

3,270

3,007

3,679

(3,530)

+29%

+ 8%

Hospital Days

66,618

58,721

47,241

40,640

38,023

(36,907)

—45%

—22%

* Figures for 1959-60 estimated as basis

of 11 months' experience for Out

-Patient Services and on basis of

10 months'

experience for In-Patient Services. All

estimates in

parenthesis.

DEPARTMENT OF MEDICINE

laboratory, X-ray and surgical facili-
ties which have been built up through
the years to meet the specific needs of
children. Although this is a report of
the Medical Department, it cannot be
emphasized too strongly that by itself
our department would amount to
little. It is the support of the other
clinical departments, including Radi-
ology, the expert technical and scien-
tific personnel and facilities available
in the Division of Laboratories and
Research, the skill and devotion of our
nurses, and the conscientious efforts of
all the supporting service departments
that give The Children's strength.

One thing is clear: consulting
practice has moved from the office of
a single experienced and wise physi-
cian to institutions such as ours. It is
as a specialized consultation and treat-
ment center for children that The
Children's Hospital Medical Center
will fulfill its unique purpose. For
such a development we need men of
great ability who can devote their full
time to this task. This requires money,
but money is not too difficult to ob-
tain, provided we select outstanding
people. At present our need is for
facilities for clinical and investigative
work which will attract and hold able
people at this institution. The short-
age of suitable facilities — well-
organized office, clinic and research
laboratory space — is becoming a very
serious handicap to progress in the
direction along which historical neces-
sity leads us and which offers the
greatest chance of solid financial sup-
port in the future.

In discussing services to patients,
we should not forget the very appre-
ciable portion of staff devoted to giv-
ing professional advice to parents, to
colleagues, and to practicing physi-
cians. Scarcely a day goes by when a
member of the full-time staff does not
advise some doctor by long-distance

telephone or write one or two letters
in answer to requests for information
about a sick child. Could these hidden
services be counted, their volume
would be surprising.

EDUCATION

Medical students

The pediatric education of students
from the Harvard Medical School con-
tinues to be a very important responsi-
bility of the department. Although a
constant effort is being made to im-
prove the quality of our teaching, no
major change will be possible until
there is a general revision of the clini-
cal curriculum of the Medical School.
An attempt is being made, within the
limitations of the allotted time, to give
the students greater contact with the
diversity of special knowledge in
pediatrics and the wealth of clinical
material to be found in The Children's
Hospital Medical Center.

House staff

The Medical House Staff is large. It
consists of the following groups:
twenty-six on the regular in-patient
house staff, eight to eleven on the out-
patient house staff, and three to five
filling a resident's function in Neu-
rology, Cardiology, and Tumor
Therapy as part of their training in
that special field of pediatrics. Last
year approximately 250 applicants
were processed for the thirty-four ap-
pointments made. It is a shameful
fact that this institution is the only
teaching hospital in Boston, and quite
possibly the only one in the country,
that does not pay a reasonable stipend
to all of its house officers; that the
niunber and quality of the applicants
should be what they are is gratifying.

Postgraduate students

Ever since the war, under Dr. R. Can-
non Eley's direction, the Department
has run a four months' postgraduate
course under the aegis of the Courses
for Graduates, Harvard Medical
School. Starting as a refresher for re-
turning veterans, the course now has
become primarily an introduction to
American pediatrics for foreign stu-
dents, most of whom have gone on
from our course to further clinical
training after becoming familiar with
our ways of doing things. In this
respect, I believe it has played a very
useful role, but one which we hope
to improve still further.

Training for research

The vast increase in funds to support
medical research since the war, as well
as the expansion in the number and
size of medical schools, has created a
tremendous demand for people with
proper training to undertake academic
careers of teaching and research. In
addition, the tremendous prestige of
American medicine has brought many
able young teachers to this country
from abroad for a period of research
training. Although training for re-
search has always been an important
function of this institution and of our
department, particularly under the late
Dr. James L. Gamble, it has grown
greatly in size and importance since
the war.

For example, during the year
covered by this report, a total of 114
individuals, of whom sixty-five were
U. S. citizens from twenty-four states,
and forty-nine citizens of twenty-nine
different foreign countries, enrolled in
one or another training program in
this department. This number in-
cludes those on the house staff, but
more than half were in research
training.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

With the support of training
grants from the National Institutes of
Health of the U. S. Public Health
Service, formal training programs for
clinical investigative careers have been
inaugurated in Cardiology, Hema-
tology, Neurology, and in General
Pediatrics with a strong focus on
metabolism. These grants are a very
hopeful development. They not only
provide additional support for staff,
but place the responsibility for selec-
tion of trainees upon the institution,
which usually knows the applicants,
instead of leaving it to a committee
which does not.

RESEARCH

Research is an essential function of the
department, not a luxury. Since this
hospital attracts such a wealth of cases
of unusual diseases, we have a particu-
lar responsibility to see that the unique
opportunity so provided is used to ob-
tain the knowledge from which alone
better understanding and improved
treatment can come for children every-
where.

Research is basically an individual
matter — it starts as a creative process
in the minds of gifted, imaginative,
curious and observant people. But it
requires hard, systematic, disciplined
work to test the validity of hypotheses.
Moreover, since the problems of disease
can be solved only by bringing basic
knowledge from the natural and medi-
cal sciences to bear on them through
the application of a variety of new
techniques, close collaboration between
interested scientists and clinicians with
scientific training and understanding is
vital. Thus, while departmental organ-
ization and clear lines of authority and
responsibility are important in the clin-
ical, educational, and administrative
work of the department, great flexi-
bility in arrangements and opportuni-
ties to cross the boundaries of depart-

ments and disciplines are equally de-
sirable for the promotion of research
by its members. Boston is a particu-
larly happy place in this regard.

Given the presence of an able,
well-trained, curious physician and the
unique opportunities at The Chil-
dren's Hospital Medical Center to
study disease in children and to col-
laborate with the great variety of sci-
entists both within and outside this
institution in the Boston area, what is
needed to make him a productive
clinical investigator? I believe there
are four essential needs which must
be met: (1) Time, (2) Security,
(3) Funds, (4) Facilities.

Time

Research requires thought, reading,
reflection, and labor, all time-consum-
ing. The full-time system was designed
to meet this requirement, freeing a
man of the necessity of devoting most
of his time to earning his living in
practice.

Security

Most clinical investigation depends
upon attracting and holding together
a group of patients the investigator
desires to study. The organization of
such a team with proper financial sup-
port takes a number of years. Thus,
a frequent turnover of staff in a clini-
cal department is wasteful. To hold
people, an opportunity to work on a
long-term basis is essential. We need
funds to underwrite several people in
the department on a permanent basis,
so that they can devote a life time to
the study of a particular area.

Funds

Funds are necessary to provide time
and security for the investigator, to
support his laboratory group and to
pay for the expenses of hospitalization

or clinic care of patients under investi-
gation. For the past few years this de-
partment has been exceedingly fortu-
nate in having a very generous grant
of approximately $100,000 per year
from the John A. Hartford Founda-
tion, which provides for the expenses
of hospitalization for research study
and treatment of patients with dis-
orders of protein synthesis, with par-
ticular emphasis upon diseases of the
blood. This grant has greatly increased
our opportunity to study patients in
the hospital, without hardship to the
patient or drain on the Hospital's re-
sources. The extent to which special
funds for research from various
sources, particularly the National In-
stitute of Health, support our work
will be apparent in the section de-
voted to the financial affairs of the
department.

Facilities

Clinical investigation, particularly in
a teaching hospital such as ours, re-
quires adequate out-patient clinic
space where ambulatory patients can
be followed, ward space where special
studies may be carried out, with offices
and laboratory space for the investi-
gators as close as possible to the wards
or clinic area. At present, the research
laboratories of the department's eleven
research groups are in nine different
buildings. In only a few instances are
the amount and type of space adequate
for its purpose, and there is no space
at present suitable for laboratories for
neurological research. Thus, the re-
search laboratory facilities of the De-
partment are scattered, poorly situated,
and inadequate, both qualitatively and
quantitatively. The Clinical Research
Building was carefully planned to
remedy many of these deficiencies; on
the basis of these plans approximately
$750,000 was obtained from the Na-
tional Institutes of Health and a lot

DEPARTMENT OF MEDICINE

more money raised from the public.
The construction of this building is an
urgent necessity, unless the Hospital
is to lose its position of leadership and
much of the grant money which it
needs to support its total program,
not only of research but of teaching
and care of children as well. These
functions are inextricably intertwined.
If we slip in one of them, we shall
slip in all.

FINANCIAL

An analysis of the source and amount
of money spent on salaries of the pro-
fessional, technical and clerical staff
under the administrative supervision
of the department underscores what
has happened over the 37 years for
which we have records: first an enor-
mous increase in total budget, with a
very small increase in the "hard"
money resources of the department;
second, the tremendous increase in
money from gifts and grants, account-
ing for 77 per cent of the total budget;
and third, the greatly increased ad-
ministrative burden placed upon those
responsible for this many people and
this much money derived from so
many different sources.

"Hard" money is needed to pro-
vide security for the key members of
the full-time staff. It is to be hoped

that the Harvard Medical Center Fund
drive will help to meet this need.
There is no better investment in the
future strength of the Hospital.

The increase in gifts and grants
and the administrative burden which
they impose, together with the growth
in size and complexity of the depart-
ment, made us feel the necessity for
an administrative reorganization
within the department. We were for-
tunate in being able to secure the half-
time services of Mr. George L.
Batchelder, Jr., starting July 1, I960.
With his experience as Business Man-
ager of Protein Foundation since 1954
and as Business Manager of the Bay
State Clinic for Rehabilitation, he
understands the complexities of the
budgetary arrangements of this depart-
ment.

Analysis of the special funds
available for the work of the depart-
ment is shown in the table below.

These very large sums are not
only evidence of the reputation which
the Staff of this Hospital enjoys but
also of the hard work of the many staff
members required to obtain these
many gifts and grants to support the
work of the institution. Further in-
creases in the amounts of money avail-
able for the extramural research pro-

SPECIAL FUNDS — DEPARTMENT OF MEDICINE

(Salary Budget Only)

HOSPITAL

Special funds — private sources $312,584

Grants from National Institutes of Health 245,314

Total Special Funds (Hospital) $557,898

HARVARD

Special funds — private sources 47,206

Grants from National Institutes of Health 103,620

Total Special Funds (Harvard) 150,826

Total, all Special Funds $708,724

Total Special Funds from private sources $359,790

Total Special Funds from government (N.I.H.) sources $348,934

grams of the National Institutes of
Health, and changes in their grant-
making policies to extend the terms
of grants, to broaden the type of sup-
port for programs more than projects,
and to permit consolidation of several
grants into one, which are mainly the
result of Dr. Sidney Farber's efforts
as a member of the National Advisory
Health Council, have been enormously
helpful to investigators throughout the
country and suggest that more and
more of our research will be supported
from the National Institutes of Health.
However, the size of the figure for
gifts from private sources should re-
assure those who fear that govern-
mental support of research would dis-
courage private giving.

PERSONNEL

During a period of fourteen months,
death has taken three of the great
figures who helped to give The
Children's Hospital Medical Center its
world-wide reputation. Dr. James L.
Gamble, whose lifetime devoted "to
the study of disease by the methods
of chemistry" affected the care of
patients in almost every branch of
medicine and helped to save countless
lives, died in May, 1959. Dr. Bronson
Crothers, whose pioneering effort to
understand the basis and management
of neurological disease and particu-
larly cerebral palsy in children, died at
his summer home in Sorrento, Maine,
in July, 1959. His book The Natural
History of Cerebral Palsy based on his
life's work, was just completed, and
he had received word only two months
before of his selection to receive the
John Howland Award of the Ameri-
can Pediatric Society. Warm, kindly,
modest, humorous, and iconoclastic,
his influence upon pediatrics, and par-
ticularly upon the long succession of
house officers who served as his "ap-
prentices" during part of their train-

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

ing at The Children's Hospital, will
last for many years. Another great
figure in child neurology, Dr. William
G. Lennox, whose life was devoted to
the study of epilepsy and who fought
courageously for better treatment for
the epileptic by society, died in July,
I960. Dr. Lennox came to the Hospi-
tal immediately after the war, found-
ing the Seizure Unit, where many
troubled parents found comfort and
expert help and here many physicians
have been trained in the total care of
patients with epilepsy. He too had
just completed his major book on
epilepsy. He had just received the
first specially bound copy from his
publisher to the affectionate applause
of hundreds of physicians, patients
and friends gathered in the Harvard
Club last July for "An Evening with
Dr. Lennox," when the ultimately fatal
cerebral accident began. The diag-
nosis and study of epilepsy have been
enormously advanced by his applica-
tion of electroencephalography with
Gibbs. He combined the attributes of
a scholar with the fervor of a mis-
sionary in his attack upon "the falling
sickness," and every epileptic is his
beneficiary.

Two important awards came to
members of the staff this past year.
At an impressive ceremony in May,
I960, at Swampscott, the John How-
land Award of the American Pedia-
tric Society was given posthumously
to Dr. Crothers for his distinguished
services to pediatrics, with tribute be-
ing read by a former house officer, Dr.
Edward L. Pratt, now Professor of
Pediatrics at Southwestern Medical
College, Dallas, Texas, and by Dr.
Randolph Byers of our staff. Dr.
Harold C Stuart, the founder of our
Child Health Division and emeritus
Professor of Child Health at the Har-
vard School of Public Health, received
the Borden Award of the American

Academy of Pediatrics at its meeting
in October 1959. These are the two
major awards in American pediatrics.

Two members of our staff have
left to assume positions of greater re-
sponsibility. Dr. Abraham M.
Rudolph, who came to us from South
Africa in 1950 and who rose from
Research Fellow to Associate Cardiol-
ogist, has gone to the Albert Einstein
Medical College, Bronx, New York, as
Associate Professor of Pediatrics in
charge of their cardiovascular work.
Dr. Felix P. Heald, who served here
first as a resident on the Tumor
Therapy Service and then was closely
associated with Dr. J. Roswell Gal-
lagher from the inception of the
Adolescent Unit, has gone to the Chil-
dren's Hospital of Washington, D. C,
to take charge of their Adolescent
Division and their program of Post-
graduate Education. Each of these men
is a loss to us, but it is through such
successive losses and renewals that
The Children's Hospital makes one of
its major contributions to the develop-
ment of pediatrics in this country.

Many members of the staff con-
tribute in a great variety of ways to
the public welfare — as trustees, com-
mittee members and chairmen and
advisors to private and governmental
organizations in their own commu-
nities, in the Commonwealth of
Massachusetts, and in the nation as a
whole. Five staff members serve in an
editorial capacity on important medi-
cal journals; one, Dr. Clement Smith,
has been Chairman of the Pediatric
Section of the American Medical Asso-
ciation, and another serves on the Ex-
ecutive Board of the International
Pediatric Association. This is no
ivory tower, but an institution whose
members are deeply involved both as
experts and as good citizens in the life
of this country.

Moreover, this activity no longer

stops at our national borders. In the
past year members of our staff have
been on professional missions to Den-
mark, Sweden, Holland, England,
Switzerland, Poland, and India. In
fact, one member, Dr. Richmond S.
Paine, has flown to England twice this
summer by request to participate in
international meetings on cerebral
palsy. The bonds which link together
those with a common interest in child
health throughout the world have be-
come as strong and as close as those
which tie us to colleagues in other
parts of our own country. The inter-
national character of pediatrics was
particularly apparent last summer
when we had the pleasure of playing
host to a stream of visitors before
and after the International Paediatric
Congress in Montreal, at which many
members of our staff played a promi-
nent role and the President of which,
Dr. Alan Ross, was a former house
officer. Last year 145 visitors from
forty-five countries came to visit the
Department.

ACTIVITIES OF THE MEDICAL
DIVISIONS

Child Health Division

Under Dr. Robert J. Haggerty's lead-
ership the Child Health Division,
founded by Dr. Harold Stuart, has
become a very important focus for
preventive and social pediatrics and
for family medicine. The effective-
ness of this division has been en-
hanced by its new quarters — the re-
modeled former Brace Shop across
Blackfan Street from the Out-Patient
entrance; this space provides adequate,
conveniently arranged offices and a
playroom, conference room above with
good clinic space downstairs. In addi-
tion, an outdoor play yard, which can
be entered from the Unit as well as
from the rear of the old houses along
Longwood Avenue where the Mater-

DEPARTMENT OF MEDICINE

nal and Infant Care program and the
Children's Mission are situated, has
been laid out and equipped with funds
from the Daffodil Club.

The Child Health Division pro-
vides staff and quarters for Well Child
Conferences sponsored by the Health
Department of Boston, in which in-
struction of medical students and
house officers in preventive pediatrics
is carried on.

A major undertaking of the Child
Health Division is the Family Health
Care Program. This is a small or-
ganized practice among 129 medically
indigent families comprising 254 chil-
dren and 258 parents living in the
vicinity of the hospital. Health pro-
tection services are provided free,
while a small charge is made for of-
fice and home visits for illness. Sta-
tistics for the year were:

Visits to Clinic

for health supervision 876

Visits to Clinic

or home for acute illness 538

Visits for chronic illness 122

Other visits (follow-up, etc.) 383

Total Patient Visits 1919

These families are cared for by the
staff under two programs: (1) A
house officer program, in which pedia-
tric residents in training assume re-
sponsibility throughout their period
of appointment for the provision of
complete pediatric care to the chil-
dren in several families, usually in-
cluding one with a child with chronic
illness; (2) a medical student pro-
gram, given as an elective course in
Family Medicine in which third year
students assume the complete medical
care of all the members of one or two
families for a year. This latter pro-
gram requires teaching from the De-
partments of Obstetrics, Medicine, and
Psychiatry of the Medical School and
from the Boston Lying-in and Peter

Bent Brigham Hospitals; parents as
well as children are seen in the new
quarters of the Child Health Division,
a great advantage in unifying this
program. The Family Health Care
Program was developed primarily for
educational purposes, to provide an
opportunity for the future pediatri-
cian to learn the skills of family prac-
tice as part of his total pediatric
training and for students to learn more
about the role and function of the
physician in his traditional task of
providing medical service to families.
It has also become a rich source of
research material in social medicine
and in the epidemiology of accidents
and respiratory infections, and should
provide an opportunity to experiment
with ways to make the work of the
family pediatrician more effective and
more satisfying in the future.

This educational pilot study has
been assisted by a large grant to the
Harvard Medical School from the
Commonwealth Fund in support of
the teaching of comprehensive pedia-
tric medicine. This grant, which has
also assisted the Adolescent Unit and
the Department of Psychiatry, will be
finished at the end of the coming year.
Exact evaluation of such a program is
difficult. We are convinced that such
a family practice is an important ad-
junct to the wards and clinics of the
hospital in the development of a well-
rounded program of clinical teaching
and research in pediatrics.

The major need of the Child
Health Division for the coming period
is financial support to permit con-
tinuity in the further development of
the teaching and research programs
which have been well established.

Adolescent Unit

Like the Child Health Division, the
Adolescent Unit has played an impor-
tant role in broadening the concept

of pediatric medicine and has ex-
tended the responsibilities of The
Children's Hospital Medical Center
beyond its walls, through participation
of its staff in school health programs,
language disability studies in schools,
and even into a summer camp pro-
gram for obese adolescent girls. In
reporting on the year Dr. J. Roswell
Gallagher writes:

'As the Adolescent Unit ap-
proaches its tenth year of operation,
its staff and its services and physi-
cian-training program seem to be
sufficiently stabilized so in the next
few years increasing attention can
be given to the development of an
appropriate research program, to
the more satisfactory bed care of
adolescents admitted to the Hospi-
tal's medical service, to the develop-
ment of a few specialty clinics for
those adolescents whose care and
study are better carried out by spe-
cialists than in a generalist setting
such as the Unit's, and to the acqui-
sition of sufficient endowment or
annual gift funds to provide for the
cost of the Unit's operation. Each
of these matters has been given con-
siderable thought, but none has been
as actively pursued in the past as
should be the case in the near fu-
ture.

"The Unit's Out-Patient Service
continues to grow and seems to be
well regarded by its patients and by
the physicians who refer patients to
it. In order to preserve the atmos-
phere which we believe best suited
to both patient care and to the train-
ing of physicians in the care of
adolescents, it would seem likely
that any further expansion of our
staff or facilities or any significant
increase in our patient load would
be undesirable. At present it is our
group's opinion that efforts should
be directed toward maintaining and

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

improving the quality of our serv-
ice rather than toward increasing its
size. Over the years the number of
serious and unusual illnesses seen
has increased considerably as has
the variety of medical problems.
This is no doubt due to a wider
public understanding of our Unit's
function and a lessening of the be-
lief that our major concern was
adolescents' behavioral disorders.
This latter understanding is also re-
flected in the decrease in the number
of serious emotional disorders re-
ferred to us: a situation which is
clearly desirable from the standpoint
of patients and hospital alike."
The work of this Unit has been
greatly assisted by a grant from the
Grant Foundation, for Staff and for
traineeships.

Cardiology Division

The growth of the activities of
this division has been steady and in-
creasingly impressive. The Cardiac
Clinic, which now must meet three
(and soon four) afternoons a week,
has a waiting list of over three months.
The Catheterization Laboratory, which
carries out approximately 500 proce-
dures per year (about 2 per working
day) has a waiting list of six to twelve
months. The Sharon Cardiovascular
Unit is kept full with patients under-
going hospital study and surgical treat-
ment of cardiac anomalies, and no
beds can be spared for needed meta-
bolic studies. As methods of diagnosis
and treatment improve, more and
more patients with congenital heart
disease survive and demand some de-
gree of follow-up care and study, thus
adding to the case load.

Dr. Alexander S. Nadas and his col-
leagues have built up one of the most
active children's cardiac units in the
world, and in consequence patients
come from a wide area for help, and

students from everywhere are seeking
training here. The department is pro-
ductive, both in terms of trained men
for academic positions elsewhere and
in terms of clinical research. However,
its growth poses very real problems.
Although its quarters seemed very
spacious two or three years ago, they
are now quite inadequate. There is
need for a research clinic, research
beds, more office space and more and
better integrated laboratory space in
the immediate future. Funds to sup-
port the work of this Division are no
problem, but the funds available can-
not be utilized unless the space needs
are met.

With Dr. Abraham M. Rudolph's
departure to assume his new duties in
New York, the experimental labora-
tory has been taken over by Dr. Robert
Grier Monroe, who has just completed
three years of research training in Dr.
James L. Whittenberger's laboratory
in the Harvard School of Public
Health.

Dr. Benedict F. Massell's program
of research on rheumatic fever is car-
ried on at the House of the Good
Samaritan. Thanks to a grant from
the National Heart Institute to provide
basic support for his research program
for a term of years, it is possible to
plan and carry out long-term studies
of the impact of the increasingly effec-
tive modern measures for prevention
and treatment upon the incidence and
outcome of this important disease.

Pulmonary Laboratory

For the past few years Dr. Charles
D. Cook has built up an increasingly
productive and useful laboratory for
the study of pulmonary physiology in
children. Although severely handi-
capped by lack of space, this labora-
tory has carried out important col-
laborative studies of pulmonary
disturbances with other groups in the

hospital — in cases of asthma, pan-
creatic fibrosis, and scoliosis and in
children under anesthesia. Its work is
supported by a grant from the Na-
tional Institutes of Health and funds
donated by the Lloyd family.

Allergy Division

The Allergy Clinic is one of the larg-
est in our Out-Patient Department
and its staff, who are all part-time
unpaid physicians, are giving the Hos-
pital a great deal of excellent service.
Since Dr. Harry L. Mueller became
Allergist two years ago, he has inaugu-
rated a research and training program
in this field, but this is still seriously
hampered by lack of funds and even
more by lack of space. A prospective
study of the development of allergic
manifestations, starting in early in-
fancy in children with a family his-
tory of allergy, is being made with a
grant from the Ross Laboratories.

Neurology Division

Dr. Randolph S. Byers, assisted by
Dr. Richmond S. Paine, has continued
to carry a tremendously heavy load of
clinical work and consultation in this
all-important area of pediatrics.

The work of the Division has been
greatly strengthened in the last few
years by several developments:

(1) Formalization of a training pro-
gram in pediatric neurology, which
has been able to utilize two oppor-
tunities in the Harvard setting, a brief
experience for each trainee with Dr.
Derek Denny-Brown at the Boston
City Hospital, and a basic course in
neuro-sciences for neurological trainees
organized by Dr. Paul Yakovlev;

(2) The development of a splendid
laboratory of Neuropathology in the
Department of Pathology under Dr.
Elizabeth Q. Banker; (3) Funds from
the grant to The Children's Hospital
Medical Center from the National

DEPARTMENT OF MEDICINE

Foundation for Neuromuscular Dis-
eases which have made these develop-
ments possible. Dr. Byers and Dr.
Banker are collaborating in a long-
term combined clinical and pathologi-
cal study of Neuromuscular Diseases
in Children which should be a very
important contribution. An excellent
group of Fellows in Neurology work-
ing with Dr. Byers and Dr. Lombroso
have stimulated both teaching and
clinical research in neurology.

The Seizure Unit, under Dr.
Cesare T. Lombroso, continues its ac-
tive program of care, teaching, and
research in the field of epilepsy. Con-
siderable investigation of the use of
the electroencephalograph for localiza-
tion of brain lesions at operation is
being carried on with the Department
of Neurosurgery as well.

The Maternal and Infant Care
Program, under the direction of Dr.
Richmond S. Paine, represents a new
and important aspect of our neurologi-
cal activities. It is responsible for
long-term follow-up of selected infants
observed by Dr. Stewart H. Clifford's
group at the Boston Lying-in Hospi-
tal through pregnancy, delivery, and
part of the first year. Together, these
two integrated programs constitute
the largest single project in the col-
laborative Study of Perinatal Factors
in Brain Damage in Children being
supported by the National Institute
for Neurological Diseases and Blind-
ness.

Hematology Division

Over the past twenty years Dr. Louis
K. Diamond has gradually built up an
exceedingly strong program of re-
search and training in pediatric hema-
tology. Beginning with simple
hematologic studies in children with
blood diseases, the group has grown
and extended its work through the

Blood Grouping Laboratory under Dr.
Fred H. Allen, Jr., into the field of
blood grouping, normal and abnormal
blood group antibodies and the treat-
ment of erythroblastosis fetalis. The
use of exchange transfusion in this
disease has not only reduced mortality
but almost eliminated an important
cause of the athetoid type of cerebral
palsy. In recent years the interests of
the Hematology Division have ex-
tended into a study of aplastic anemia,
with encouraging results from the use
of certain steroid hormones in treat-
ment. A clotting laboratory, headed by
Dr. Campbell W. McMillan, is study-
ing the metabolism and the physio-
logic and therapeutic effects of human
clotting proteins, prepared by Protein
Foundation, in patients with hemo-
philia and other hereditary disorders
of coagulation. Under Dr. Park S.
Gerald and Dr. Mary Efron, both of
whom have recently returned from
genetic and biochemical training in
England, an excellent laboratory for
the study of the chemical structure of
abnormal hemoglobins and the rela-
tion between genetics, chromosomal
abnormalities, and the synthesis of
certain blood proteins has been set up.
In fact these laboratories provide an
ideal nucleus for a center for the study
of human genetics, one of the real
frontiers of modern pediatrics. These
investigations have been made possible
by grants from the National Heart In-
stitute and the John A. Hartford
Foundation, Inc.

Metabolic Diseases

Metabolic problems remain a central
concern of the full-time staff of the
department and provide the focus for
our training program for future pedia-
tric investigators. The laboratories are
scattered, but the group meets regu-
larly for critical discussion of research
in progress.

( 1 ) Kidney diseases and mineral
metabolism are the prime interests of
Dr. Francis X. Fellers, who continues
to use the chemical laboratories estab-
lished by Dr. James L. Gamble. In
addition to supervising the care and
study of patients with nephrosis, with
assistance from the New England Kid-
ney Disease Foundation, Dr. Fellers is
actively investigating the metabolism
of Vitamin D and renal tubular dis-
eases.

(2) Laboratories for the study of
protein metabolism under Dr. David
Gitlin are temporarily located in
beautiful new laboratory space loaned
by the Children's Cancer Research
Foundation. Here a group is inten-
sively studying a number of features
of the basic processes of protein
synthesis with a constant effort to
apply the knowledge and techniques
developed in the laboratory to an
understanding of human disease. Sup-
port for these laboratories comes from
the National Institute of Arthritis and
Metabolic Diseases and from the
American Heart Association.

(3) Endocrine Laboratories were
established a few years ago under Dr.
John F. Crigler, Jr., in unused labora-
tory space in the House of the Good
Samaritan. After a few years these
laboratories have been filled to capa-
city. Dr. Norman I. Gold, a talented
steroid biochemist, and Dr. Jerome A.
Grunt, a teacher of anatomy now
turned pediatrician, have joined the
laboratory and supervise the training
of an active group of fellows. With
help from many sources, including the
Ten-Aiders, the National Institutes of
Health, the Medical Foundation, and
some private gifts, these laboratories
have been equipped and staffed, and
the Endocrine group is now making a
vital contribution to care, teaching
and research in this Hospital.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

It is impossible to give more than
a bird's-eye view of the activities of
these various groups interested in one
or another special field of pediatrics.
Certain gaps in our coverage of medi-
cal problems will be noted. Problems
of the newborn are under particularly
intensive study at the Boston Lying-
in Hospital by Dr. Clement A. Smith's
team. Nutritional diseases and pan-
creatic fibrosis are cared for and
studied by Dr. Harry Shwachman, with
his research laboratories in the Divi-
sion of Clinical Laboratories. Infec-
tious diseases are under investigation
by Dr. John F. Enders and his asso-
ciates in the Division of Infectious
Disease Research. There are a num-
ber of other instances where impor-
tant segments of pediatrics are being
studied in other departments. This is
all to the good. Pediatrics is the medi-
cine, surgery and pathology of the
human during the period of growth
from conception through adolescence.
It needs the interest, effort and
thought of men from every discipline,
if its many problems are to be solved
to provide better health for the com-
ing generation.

NEEDS

The needs of the Department of Medi-
cine are, first of all, the needs of all
the departments of the Hospital —
adequate stipends for house officers
and new endowment to support key
members of the staff on a secure long-
term basis in each department. One
department should not grow strong at
the expense of another. The Hospital,
since its services to patients, it teach-
ing, and its research depend upon
interdepartmental cooperation, should
be a "balanced ship" as far as possible.
Two new ventures started in the
last decade, which have been sup-
ported by temporary grants in their
infancy, now require more lasting sup-

port — the Child Health Division and
the Adolescent Unit.

Perhaps the most critical need is
for the construction of facilities for
clinical research — offices, special clin-
ics, laboratories, record room, and li-
brary — in close proximity to the wards
or out-patient clinics. Without these
new facilities, in the near future, the
momentum of the Hospital's develop-
ment will be lost, the morale of the
Staff will be impaired, and the funds
which finance so much of our work
will be harder to obtain. In prepara-
tion for this, we are doing everything
possible, assisted by the improved
Hospital accounting system, to put the
financial affairs of the department in
order. But we believe that it is im-
perative that we move ahead as
rapidly as possible with the develop-
ment of final plans for construction
of the Clinical Research Building.

Charles A. Janeway, M.D.
Physician-in-Chiej

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Bucci, G., Cook, C. D., and Barrie,
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children and adults. Fed. Proc, 19:
377, 1960.

DEPARTMENT OF MEDICINE

Cook, C. D., O'Brien, D., Hansen, J.
D. L., Beem, M., and Smith, C. A.,
Water and electrolyte economy in
newborn infants of diabetic mothers.
Acta Paediat., 49:121, I960.

Earle, D. P., Hutt, M. P., Schmid, K.,
and Gitlin, D., Observations on
double albumin: a genetically trans-
mitted serum protein anomaly. /.
Clin. Invest., 38:1412, 1959.

Eley, R. C, Diphtheria. Method of R.
Cannon Eley, M.D. In Conn, H. F.
(Ed.), Current Therapy. Saunders,
1959.

Fellers, F. X., Idiopathic hypercalcemia
of infancy and vitamin D metabo-
lism. Helvetia Paediat. Acta, 14,
1959.

Ferris, B. G., Jr., and Cook, C. D.,
Respiratory physiology and its ap-
plication to pulmonary disease. In
Nelson, W. E. (Ed.), Textbook of
Pediatrics. Saunders, 1959-

Gitlin, D., Immunochemistry and its
relationship to atherosclerosis. In
Connective Tissue and Atherosclero-
sis. Academic Press, 1959.

and Janeway, C. A., Turnover

of the copper and protein moieties
of ceruloplasmin. Nature, 18.5:693,
1960.

Gitlin, D., Janeway, C. A., Apt, L., and
Craig, J. M., Agammaglobulinemia.
In Lawrence, H. S. (Ed.), Cellular
and Humoral Aspects of the Hyper-
sensitive States. Hoeber, 1959.

Gold, N. I., Intermediary metabolism
of Cortisol. Symposium on metabo-
lism after trauma. Metabolism, 8:
878, 1959.

, Smith, L. L., and Moore, F. D.,

Cortisol metabolism in man: obser-
vations of pathways, pool sizes of
metabolites and rates of formation
of metabolites. J. Clin. Invest., 38:
2238, 1959.

Janeway, C. A., Agammaglobulinemia.
In Cecil and Loeb, Textbook of
Medicine, 10th ed. Saunders, 1959.

, Infection, immunity and al-
lergy in relation to pediatrics. In
Nelson's Textbook of Pediatrics, 7th
ed. Saunders, 1959.

-, Infections with the coliform,

proteus, and pseudomonas groups of
bacilli. In Cecil and Loeb, Textbook
of Medicine, 10th ed. Saunders,
1959.

James Lawder Gamble. 1883-

1959. Harv. Med. Alumni Bull.,
July 1959, 4.

-, James Lawder Gamble. 1883-

1959. Pediatric profiles. /. Pediat..
56:101, I960.

-, Lymphocytic choriomeningitis.

In Cecil and Loeb, Textbook of
Medicine, 10th ed. Saunders, 1959-
-, The scholar and the devil's

advocate. In Report of the First
Institute on Clinical Teaching. /.
Med. Educ, 34:79, 1959.
, The student, the patient, and

the teacher as seen by Institute par-
ticipants. In Report of the First
Institute on Clinical Teaching. /.
Med. Educ, 34:101, 1959.

et al. Designated discussion.

In Mechanisms of Hypersensitivity,
International symposium, Henry
Ford Hospital, Detroit. Little Brown,
1959.

Kamat, V. B, Hoelzl Wallach, D. F.,
Crigler, J. F., Jr., and Ladman, A. J.,
The intracellular localization of
hormonal activity in transplantable
thyrotropin-secreting pituitary
tumors in mice. /. Biophys. &
Biochem. Cytol, 7:219, I960.

Katz, R. A., Intravenous urea in the
therapy of increased intracranial
pressure with lead encephalopathy.
N. E. J. Med., 262:870, I960.

Kevy, S. V., Chief resident symposium.
How they run their pediatric serv-
ices. Res. Physic, 6:66, I960.

Korn, D., Demonstration of cystine
crystals in peripheral white blood
cells in a patient with cystinosis.

N. E. J. Med., 262:545, I960.

Lathrop, D. B., Cystic disease of the
liver and kidney. Pediatrics, 24:215,
1959.

Pendleton, M. E., Adrenal hemorrhage
and retroperitoneal hematoma fol-
lowing perinatal stress. /. Pediat.,
56:308, I960.

Smith, C A., Circulatory factors in re-
lation to idiopathic respiratory dis-
tress (hyaline membrane disease)
in the newborn. /. Pediat., .56:605,
1960.

, Neonatal pediatrics, Part III.

Prevention of prenatal and neonatal
deaths. Am. Pract. & Dig. of Treat-
ment, 2:265, I960.

-, Overuse of milk in the diets

of infants and children. J.A.M.A..
172:567, I960.

-,The newborn infant. J.A.M.A.,

272:433, I960.

-, Physiology of the Newborn

Infant, 3rd ed. Thomas, 1959-
— , The professor, the student,

and the newborn infant. Univ. Mich.
Bull, 15:293, 1959.

Snedeker, L. E., et al., Care of Children
in Hospitals. American Academy of
Pediatrics, I960.

Sutherland, J. M., Oppe, T. E., Lucey,
J. F., and Smith, C. A., Leg volume
changes observed in hyaline mem-
brane disease. Am. J. Dis. Child.,
98:24, 1959.

Whittenberger, J. L., and Cook, C. D,
Neonatal resuscitation. Merck,
Sharpe & Dohme, Seminar Report,
4:22, 1959.

Adolescent Division:

Gallagher, J. R., About people, not in-
juries. Am. J. Surg., 98:332, 1959.

, Adolescents: Their character-
istics and care. Survey Paper. White
House Conference on Children and
Youth, I960.

-, General principles in clinical

care of adolescent patients. Pediat.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Clin, of N. Am., 7:185, I960.

-, Medical Care of the Adoles-

cent. Appleton-Century-Crofts, I960.
-, Meeting the needs of the hos-

pitalized adolescent. In Care of
Children in Hospitals. American
Academy of Pediatrics, I960.
, Problems of adolescents in

school and residential settings.
Workshop on Emotional Problems
of the Indian Students in Boarding
Schools and Related Public Schools.
Albuquerque, N. Mex., April I960.
-, Specific language disability

(dyslexia). Clin. Proc. of Child.
Hosp. (Washington, D.C.), 16:1,
1960.

and Harris, H. I., Psychiatry:

behavioral problems in the adoles-
cent. Ann. Rev. of Med., 11:275,
I960.
and Locke, W. N., Foreword.

In Hermann, K., Reading Disability.

Thomas, I960.
Heald, F. P., Obesity in the adolescent.

Pediat. Clin. ofN. Am., 7:207, I960.
and Sturgis, S. H., Adolescent

gynecology: a 5 -year study. Pedi-
atrics, 25:669, 1960.
Masland, R. P., Jr., Ulcerative colitis.

Pediat. Clin, of N. Am., 7: 197, I960.
Peckos, P. S., Spargo, J. A., and Heald,

F. P., Program and results of a camp

for obese adolescent girls. P. G.

Med., 27:527, I960.
Williams, M., A clinic for adolescents:

a survey of 750 patients. Med. J.

of Australia, Aug. 15, 1959, 201.

Allergy Division:

Hill, L. W, and Mueller, H. (Eds.),

Pediatric allergy. Symposium. Ped.

Clin. N. Am., 6: No. 3, 1959-

Cardiology Division:

Nadas, A. S., Approach to diagnosis of
congenital heart disease without re-
course to special tests. Circulation,
20:602, 1959.

and Hauck, A. J., Pediatric as-

pects of congestive heart failure.
Circulation, 21 : 424, I960.

Reynolds, J. L., Nadas, A. S., Rudolph,
A. M., and Gross, R. E., Critical
congenital aortic stenosis with mini-
mal electrocardiographic changes. A
report on two siblings. N. E. J. Med.,
262:276, I960.

Rudolph, A. M., Kurland, M. D., Auld,
P. A. M., and Paul, M. H. (with the
technical assistance of Sara R. Dun-
can and Mary E. Stone), Effects of
vasodilator drugs on normal and
serotonin-constricted pulmonary ves-
sels of the dog. Am. J. Physiol.,
197:617, 1959.

and Auld, P. A. M., Physical

factors affecting normal and
serotonin-constricted pulmonary ves-
sels. Am. J. Physiol., 198:864, I960.

Rudolph, A. M., Auld, P. A. M., and
Golinko, R. J., Effects of changes
of systemic and pulmonary arterial
and venous pressures on bronchial
collateral flow. Fed. Proc, 79:March,
1960.

, Factors affecting bronchial

collateral flow in the dog. Am. J.
Physiol., 198:1166, I960.

Sasahara, A., Rudolph, A. M., Hoff-
man, J. I. E., and Hauck, A. J., Ven-
tricular fibrillation during catheter-
ization of the right side of the heart
terminated successfully by external
defibrillation. N. E. J. Med., 261:
261, 1959.

Young, E., Liebman, J., and Nadas,
A. S., The normal vectorcardiogram
of children. Am. J. Cardiology, 5:
457, 1960.

Child Health Division:

Cook, C. D., Barrie, H., Helliesen, P.,
Mycetismus (amanita phalloides).

Haggerty, R. J., Deaths from perma-
nent antifreeze ingestion. N. E. J.
Med., 261:1296, 1959.

, Methyl alcohol poisoning.

N. E. J. Med., 262:367, 1960.

and Ziai, M., Acute bacterial

meningitis in children. A controlled
study of antimicrobial therapy, with
particular reference to combinations
of antibiotics. Pediatrics, 25:742,
I960.

Lowe, B., Acute mercury poisoning.
N. E.J.Med., 261:409, 1959-

Rosen, F. S., Parathion. N. E. J. Med.,
262:1243, I960.

Salber, E. J., Rejection of breast feed-
ing. Med. Times, 88:430, I960.

Stuart, H. C, Evaluation of growth
data. 7. Pediat., 55:803, 1959.

, The search for knowledge of

the child and the significance of his
growth and development — examples
from the Harvard Longitudinal
Studies. Borden Award Address.
Pediatrics, 24:701, 1959.

et al., Longitudinal studies of

child health and development, Series
II. Supplement to Pediatrics, 24:
875, 1959.

Hematology Division:

Allen, F. H., Jr., Case records of the
Mass. Gen. Hosp., case 45391. N. E.
J.Med., 261:658,1959.

, Erythroblastosis fetalis. Lec-
ture notes for third year medical
students. Harvard Med. School Dept.
of Obstet. & Gynecol., 1959.

-, Minimizing transfusion risks.

Mass. Physic, 28:273, I960.

-, Rational blood replacement

in the surgical patient. Conn. Med..
24:364, I960.
, Review of the new blood

group factors. Quart. Rev. Pediat.,
15:13, I960.
, Corcoran, P. A., and Ellis,

F. R., Some new observations on
the MN system. Vox Sanguinis, 5:
224, I960.

-, and Diamond, L. K., Erythro-

blastosis fetalis: attempts at preven-
tion by desensitization (abstract).
Am. J. Dis. Child., 98:503, 1959.
-, von Bercken, T., and Boyce,

S. J., Crossmatching of blood for

DEPARTMENT OF MEDICINE

massive transfusion. Bull. Am.
Assoc. Blood Banks, 12:267, 1959.
-, Corcoran, P. A., Allen, F. H.,

Jr., Allison, A. C, and Blumberg,
B. S., Blood groups of Alaskan Eski-
mos and Indians. Am. J. Phys. An-
throp., 17:187, 1959.
, Sickles, G. R., and Allen, F. H.,

Jr., Anti-C (Anti-rh) identified by
absorption technic. Bull. Am. Assoc.
Blood Banks, 13:234, I960.

Jones, A. R., and Kaneb, L., A new
property of iso-agglutinins of the
ABO blood group system. Blood,
14:1094, 1959.

, Some properties of cross re-
acting antibody of the ABO blood
group system. Blood, 1.5:395, I960.

Jones, A. R., Kaneb, L., and Abra-
hamov, A., A technique for the
titration of "cross-reacting antibody"
in group O serum. /. Lab. & Clin.
Med., 54:11% 1959.

Shahidi, N. T., and Diamond, L. K.,
Enzyme deficiency in erythrocytes in
congenital nonspherocytic hemolytic
anemia. Pediatrics, 24:245, 1959.

, Skull changes in infants with

chronic iron-deficiency anemia. N.
E.J.Med., 262: 137, I960.

, Testosterone-induced remis-

sion in aplastic anemia. Am. J. Dis.
Child., 98:293, 1959.

Good Samaritan Division:
Bland, E. F., Declining severity of rheu-
matic fever: a comparative study
of the past four decades. N. E. J.
Med., 262:597, I960.

Neurology Division:

Burnstine, R. C, and Paine, R. S.,

Residual encephalopathy following

roseola infantum. Am. J. Dis. Child.,

98:144, 1959.
Crothers, B., and Paine, R. S., The

Natural History of Cerebral Palsy.

Harvard, 1959.
Lennox, W. C, with collaboration of

M. A. Lennox, Epilepsy and Related

Disorders. Little, Brown, I960.

Lombroso, C. T., and Forsythe, I., A
long-term follow-up of acetazola-
mide (Diamox) 1 in the treatment
of epilepsy. Epilepsia, 1:493, I960.

Paine, R. S., Evaluation of familial bio-
chemical determined mental retard-
ation in children, with special refer-
ence to aminoaciduria. N. E. J. Med.,
262:658, I960.

Papers published by members of
the Department of Medicine on
work carried out in the division
of Laboratories and Research:
Crocker, A. C, and Landing, B. H.,
Phosphatase studies in Gaucher 's
disease. Symposium on hereditary
metabolic diseases. Metabolism, 9:
341, 1960.
Evans, A. E., Roentgen therapy of cer-
tain complications of acute leuke-
mia in childhood. M. J. Roentgenol.,
82:541, 1959.
Ghadimi, H., and Shwachman, H., De-
tection of aminoaciduria in retarded
children by a simple, rapid method.
In Bowman, P. W., and Mautner,
H. V. (Eds.), Mental Retardation:
Proceedings of First International
Medical Conference. Grune & Strat-
ton, I960.
, A screening test for amino-
aciduria. N. E. J. Med., 261:998,
1959.

-, Evaluation of aminoaciduria

in infancy and childhood. Am. J.
Dis. Child., 99:451, I960.

Ghadimi, H., Stern, M., and Shwach-
man, H., A study of the free amino
acids in sweat from patients with
cystic fibrosis. Am. J. Dis. Child.,
99:333, I960.

Green, M. N., Rickstniece, E., Valdes-
Diaz, O., and Shwachman, H., Elim-
ination of background staining in
the periodic acid-Schiff method for
protein-bound carbohydrates in
paper electrophoresis. /. Lab. &

Clin. Med., 55:158, I960.

Enders, J. F., Katz, S. L., and Medearis,
D. N., Jr., Recent advances in
knowledge of the measles virus. In
Rutgers University Institute of
Microbiology, Perspectives in Virol-
ogy. Wiley, 1959.

Katz, S. L., and Enders, J. F., Immuni-
zation of children with a live at-
tenuated measles virus. Am. J. Dis.
Child., 98:605, 1959.

Kibrick, S., Role of coxsackie and
ECHO viruses in human disease.
Med. Clin, of N. Am., 43:1291,
1959.

Reich, P., Shwachman, H., and Craig,
J. M., Lycopenemia. A variant of
carotenemia. N. E. J. Med., 262:
263, I960.

Shwachman, H., Clinical pathological
conference. /. Pediat., 56:551, I960.

, Cystic fibrosis. In Collier's

Encyclopedia. Collier, I960.

-, Nutrition of children with

congenital metabolic disorders. Fed.
Proc, 18:22, 1959.

Therapy of cystic fibrosis of

the pancreas. Pediatrics, 25:155,
I960.

-, Fekete, E., Kulczycki, L. L.,

and Foley, G. E., Effect of long-
term antibiotic therapy in patients
with cystic fibrosis of the pancreas.
In Antibiotics Annual, 1958-1959.

DEPARTMENT OF SURGERY

REPORT OF
SURGEON-IN-CHIEF

In I960 the general Surgical Service
of The Children's Hospital Medical
Center has had the busiest year in its
history. A study of statistics over the
past three decades shows that during
the latter half of the thirties and
through the war years, our operative-
load ran rather consistently between
1,300 and 1,400 per year. Following
the war there was a crescendo in ac-
tivities, indicated by a progressive
increase in the number of operations
up to about 1,700 in 1945 and 1946.
Since that time, there has been an ir-
regular load, but a general advance.
In the current year, as the table below
shows, a total of 2,732 operations was
performed, about twice the number of
fifteen years ago.

OPERATIONS ON

GENERAL SURGICAL SERVICE

October 1, 1959 to September 30, I960

Abdominal surgery 526

Hernias 434

Thoracic surgery 519

Genito-urinary surgery 388

Head and Neck conditions 163

Plastic surgery 189

Excision of Surface lesions 101
Extremity surgery 81

Diagnostic procedures 177

Miscellaneous 154

Total operations

2732

A review of the current patients
on our Service shows that there is a
widespread use of surgical therapy in
handling abdominal conditions, intra-
thoracic anomalies, cardiac malforma-
tions, urological conditions, to men-
tion but a few. Babies and children
are not immune to problems requiring
surgical treatment, and indeed our ex-
perience indicates that a large number
of children in the early years enter
life-and-death struggles for which
surgical management must be avail-

able. While one of the miracles of
human life is the constancy in forma-
tion of the intricate mechanisms and
systems of the living body, the fact
remains that at times these complex
developments do go awry. Thus par-
ents are presented with a baby with a
serious abnormality of intestine, lung,
heart, kidney, bladder or other organs.
One might believe that such mal-
formations are rare, yet we find that
1,818 operations were performed here
last year for the correction of various
deformities. (This figure does not in-
clude statistics from our other surgical
services — the neurosurgical, ortho-
pedic, or otolaryngological — which
handle anomalies in their respective
fields.)

As one studies in detail the kinds
of cases which have been brought to
our attention during the last two and
one-half decades, it is immediately
evident that there is an outstanding
difference between a surgical service
such as ours and that of a general
surgical service in a standard com-
munity hospital. In the latter one finds
rather uniformly the same types of
cases, year after year, but in increasing
numbers in recent years. Conversely,
in a children's hospital there always
have been definite peaks in types of
patients. It is characteristic to have a
concentration in certain types of cases
for a period, followed in subsequent
years by a fall-off in case-load of this
particular problem. Developments
which originate at our Center have a
tendency to attract the kind of patient
for which this given technique is help-
ful. However, as such a surgical pro-
cedure becomes refined and can be
made routine, this kind of surgery is
gradually taken up in outlying hospi-
tals; hence, there is a corresponding
fall-off in this kind of illness coming
into our Center.

Thus, the increase in total num-

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

ber of operative cases per year (indi-
cated above) is not merely a continual
build-up of the same forms of opera-
tions which we had fifteen or twenty
years ago. Instead, there have been
successively a number of conditions
which have been attacked here, be-
cause we could show the way to con-
quer in new territories. Newer tech-
niques have constantly brought an
ever wider variety of cases. Indeed,
this is as it should be, for a Center
such as ours should be constantly on
the march. Our largest job is to pro-
vide initiative and a newer, better
way of doing things. After we can
perfect a technique, such learning
should be passed on and employed as
routine care in other hospitals in the
state and throughout the country.

An objective view of our posi-
tion in surgery in the United States
makes it evident that our Surgical
Service is not going to progress in size
in the future, or even maintain its
present level, if we merely rest on our
laurels and continue to practice sur-
gery as we know it today. For a con-
tinuing growth there must be an in-
vestigative spirit if we are to develop
and offer to the public new and im-
proved devices and methods of han-
dling some of the baffling problems
which children are always presenting
to us. The Surgical Service feels em-
phatically that its future depends
largely on what we can develop from
the Animal Laboratory for Surgical
Research, and from our analytical ef-
forts at the level of clinical investiga-
tion. We must continually have new
tricks, because only if we can pull a
new rabbit out of the hat from time
to time, can we hope to have a chil-
dren's surgical section which is vigor-
ous and growing.

To sum up the activities of a
surgical department might sound like
a cold review of statistics and a dis-

play of operative techniques which
give us some justifiable pride, but we
must never lose sight of the fact that
we are dealing with human lives, at-
tractive children, and valuable mem-
bers of society. It is important to
emphasize that high technical skill
and modern scientific management of
surgical disease must always be accom-
panied by understanding, by warmth,
and by a friendly spirit, a realization
that the youngster has feelings, emo-
tions, and distress. Among his many
problems, physical and psychic, there
is often uppermost in a child's con-
sciousness a sense of profound loss or
abandonment, engendered by the tem-
porary separation from his home en-
vironment. In an institution which
grows like ours, there could be some
fear that augmentation in size is un-
avoidably accompanied by relaxation
in personal attention to patients and
their families. Fortunately, I think
the entire staff of The Children's
Medical Center is constantly aware
that while we have illnesses to treat,
we also have children to handle and
keep as happy as possible. In my files
are literally hundreds and hundreds of
letters, voluntarily and spontaneously
written by parents, expressing thanks
for the manner in which the staff doc-
tors, the residents and interns, and the
nurses have cared for their loved ones.
No surgical service can progress
very far without a closely integrated
Out-Patient Department. Through
these portals come a high percentage
of patients who eventually enter the
house for major surgical work. It is
therefore highly important that our
Out-Patient Department be of a na-
ture which will constantly attract new
subjects. Further, almost all surgical
cases require some measure of post-
operative care and supervision, which
are performed in the Out-Patient clin-
ics or offices. These services should be

carried out for youngsters and their
families in as quiet an atmosphere as
possible, and in a place which is as
attractive as we can make it. Good
postoperative handling of patients and
the writing of an accurate, prompt re-
port to referring physicians have much
to do with the building up in the
minds of parents and outside doctors
the thought that our services are com-
petent, kindly, and efficient. These im-
pressions determine to a considerable
extent the number of patients which
will be referred to us in the future.
Hence, it is highly important for us to
strengthen the Out-Patient Depart-
ment, and make it a first-class part of
our plant and activity. I am pleased to
report that the Trustees have agreed
to a refurbishing and redecorating of
the Surgical Wing of the Out-Patient
Department, which will begin very soon.

During the greater part of 1959, the
Laboratory for Surgical Research had
to shut down its routine activities com-
pletely, because of the extensive mod-
ernization and equipping of the unit,
with the adding of a new floor above
for animal quarters. Towards the end
of that year investigative endeavors
gradually resumed, and during I960
they have been in full swing, and are
intense and productive. We have been
fortunate in having Dr. Samuel R.
Schuster spend a large part of his time
in the Laboratory, and are very happy
to have Dr. William F. Bernhard with
us as a full-time leader in research en-
deavors. Under these men, there have
been four Research Fellows, two Re-
search Assistants, and during the sum-
mer several medical students.

A number of projects are currently
under study, including: 1. The use and
control of profound hypothermia, to
facilitiate operations on the heart and
brain, and also to help in removal of
some large tumors which otherwise
are thought to be inoperable. 2. A

DEPARTMENT OF SURGERY

study of blood circulation outside of
the body in small subjects under 15
pounds. 3. A study of various pros-
theses and appliances, for replacement
of damaged heart valves. 4. A study
of the prevention of adhesions within
the abdominal cavity, a complication
which has long baffled clinical surgeons,
particularly those interested in surgery
of early life. 5. The setting up and
production of various artificial shunts
within the heart or regional blood ves-
sels, to simulate some of the congeni-
tal cardiovascular shunts in children,
thus giving us a basis for the study of
the disturbed states made by these leak-
ages. 6. A review and testing of vari-
ous plastic materials, which might be
helpful in the construction of an arti-
ficial abdominal wall, looking forward
to the possibility of better treatment
for babies who have large omphalo-
celes (hernias of the navel).

I feel that we can be quite proud
of the Laboratory for Surgical Research.
It is now housed in excellent modern
quarters, has a high-grade staff, and
allows us to push forward on many
lines of investigation which will bring
us new or improved techniques for
handling many of the distressing con-
genital anomalies which constantly
come to our hospital door for help.
The Laboratory budget runs something
over $100,000 per year. Funds to
underwrite this have been generously
made available to us through grants
from the United States Public Health
Service, the American Heart Associa-
tion, the Godfrey M. Hyams Trust,
and literally hundreds of individual
donors interested in seeing this work
progress as rapidly as possible.

Listed below are recent publica-
tions from various members of the
general Surgical Staff.

Robert E. Gross, M.D.
Surgeon-in-Chiej

Bibliography

Bernhard, W. F., and Gross, R. E.,
Extracorporeal circulation and pro-
found hypothermia. A new surgical
technique. Proc. N. E. Cardiovasc.
Soc. (In press.)

Bernhard, W. F., Schwarz, H. F., and
Gross, R. E., Metabolic alterations
associated with profound hypo-
thermia and extracorporeal circula-
tion in the dog and man. ( In press. )

Bernhard, W. F., Schwarz, H. F., Leand
P. M., and Carr, J. G., Studies in
balanced hypothermic perfusion.
Surg., Gynec, & Obst. (In press.)

Bernhard, W. F., Schwarz, H. F., and
Mallick, N. P., Elective hypothermic
cardiac arrest in normothermic ani-
mals. Ann. Surg. (In press.)

, Intermittent cold coronary

perfusion as an adjunct to open
heart surgery. Surg., Gynec, Obst.,
7/1:744, I960.

-, Profound hypothermia as an

adjunct to cardiovascular surgery.
/. Thoracic Surg. (In press.)

Gross, R. E., Farber, S., and Martin,
L. W., Neuroblastoma sympatheti-
cum. A study and report of 217
cases. Pediatrics, 23:1179, 1959.

Gross, R. F., Sauvage, L. R., Pontius,
R. G., and Watkins, E., Jr., Experi-
mental and clinical studies of a
siphon-filling disc-oxygenator sys-
tem for complete cardiopulmonary
by-pass. Ann. Surg., 1.52:285, I960.

Gross, R. F., Schwarz, H. F., Mallick,
N. P., and Bernhard, W. R, Herzstill-
stand durch kalte coronarperfusion
in normal warmen tier. Swiss J.
Med. (In press.)

Gross, R. F., and Woolley, M. M.,
Esophageal atresia and tracheoeso-
phageal fistula. (In press.)

Hoffman, J. I. E., Rudolph, A. M.,
Nadas, A. S., and Gross, R. E.,
Pulmonic stenosis, ventricular septal
defect, and right ventricular pressure
above systemic level. Circulation,

XXU-A05, 1960.

Holder, T. M., and Gross, R. E.,
Temporary gastrostomy in pediatric
surgery. Experience with 187 cases.
Pediatrics, 26:36, I960.

Longino, L. A., and Holder, T. M.,
Rectal bleeding in infants and chil-
dren. Ped. Clin. N. Am., 6:1153,
1959.

Longino, L. A., Woolley, N. M., and
Gross, R. E., Esophageal replace-
ment in infants and children with
use of a segment of colon. J. A.M. A.,
171:1187, 1959.

Mansfield, P. B., An apparatus for elec-
tive fibrillatory cardiac arrest in
experimental and clinical cardio-
pulmonary by -pass surgery. /.
Thoracic & Cardiovasc. Surg. (In
press.)

Nadas, A. S., Rudolph, A. M., and
Gross, R. E., Pulmonary arterial
hypertension in congenital heart
disease. Circulation, XXII: 1041,
1960.

Redo, S. F., Nadas, A. S., and Gross,
R. E., Atresia of the mitral valve.
(In press.)

Replogle, R. L, and Gross, R. E., Renal
circulatory response to cardiopul-
monary by-pass. In Surg. Forum
46th Clin. Cong., American College
of Surgeons, I960.

Richardson, W. R., and Watkins, E.,
Blood volume studies in pediatric
surgical patients. In Surg. Forum
46th Clin. Cong., American College
of Surgeons, I960.

Sasahara, A. A., Nadas, A S., Rudolph,
A. M., Wittenborg, M. H., and
Gross, R. E., Ventricular septal de-
fect with patent ductus arteriosus.
A clinical and hemodynamic study.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

REPORT OF
ANESTHESIOLOGIST

Circulation, XX7I:254, I960.

Sauvage, L. R., and Gross, R. E.,
Observations of experimental grafts
in the intrathoracic venae cavae.
Surg., Gynec, Obst., 110:569, I960.

Sauvage, L. R, Gross, R. E., Rudolph,
A. M., Pontius, R. G, and Watkins,
E., Jr., An experimental study of
tissue and prosthetic grafts with
selected application to clinical in-
tracardiac surgery. Ann. Surg. (In
press.)

Sauvage, L. R., Pontius, R. G, Watkins,
R, Jr., and Gross, R. E., Simple
technique for implantation of ex-
perimental grafts in the outflow
tract of the right ventricle. A note
on defibrillation of the hypothermic
canine heart. Ann. Surg., 132:65,
I960.

Sauvage, L. R., Rudolph, A. M., and
Gross, R. E., Experimental replace-
ment of the aortic arch by homo-
grafts. /. Thoracic & Cardiovasc.
Surg., 40:61, I960.

, Replacement of the main

pulmonary artery bifurcation by
autogenous pericardium. /. Thoracic
& Cardiovasc. Surg., 40:56, I960.

Schuster, S. R., Contribution to surgi-
cal section of Gallagher, J. R.,
Medical Care of the Adolescent.
Appleton-Century-Crofts, I960.

, Diaphragmatic hernias in in-
fants and children. Quart. Rev.
Pediat, 15:171, I960.

-, The recognition and manage-

Wesolowski, S. A., Sauvage, L. R.,
Sawyer, P. N., Karlson, K. E., and
Fox, L., The growth of cardiovascular
chambers following cardiac and
aortic surgery. /. Thoracic & Cardio-
vasc. Surg., 40:692, I960.

ment of diaphragmatic hernias in
infancy and childhood. (In press.)

Smith, E. I., and Gross, R. E., The ex-
ternal anal sphincter in cases of
imperforate anus. A pathological
study. (In press.)

Shwachman, E. E. H., and Hendren,
W. H., Intestinal obstruction of the
newborn infant. Usefulness of the
sweat electrolyte test in differential
diagnosis. N. E. J. Med., 264:13,
1961.

The year I960 was one of average ac-
tivity for the Anesthesia Service. An-
esthesia was administered for approx-
imately 5,000 operations; this total
included a sizeable number of ortho-
pedic, neurosurgical, and cardiovascu-
lar procedures.

The most exacting problems con-
tinue to be met in newborn infants
undergoing correction of serious con-
genital anomalies including intestinal
atresias, omphalocele, diaphragmatic
hernia and tracheo-esophageal fistula.
Special attention was focussed on this
phase of our work in the past year.
Progress was made in techniques of
administration, but more especially in
methods of maintaining physiological
stability of the infants. The use of
specially constructed infant blood pres-
sure apparatus and of continuous meas-
urement of body temperature has been
of considerable help.

A major attempt has been made
to prevent and control shock during
extensive operations in infants and
children, this being at present our
greatest single problem in anesthesia.

Considerable effort continues to be
devoted to teaching. At present, resi-
dents in anesthesia come to this Hos-
pital on regular rotation from five
other teaching hospitals (Peter Bent
Brigham, Massachusetts General, Lahey
Clinic, Massachusetts Memorial Hos-
pitals, and University of Miami).
These residents come for periods of
three or four months. In addition,
training is offered on a fellowship basis
to physicians who have completed res-
idency requirements, but who wish to
devote six months or more to special
training in pediatric anesthesia.

Scientific investigations have been
carried on chiefly at a clinical level.
This year marked the introduction of
a new general anesthetic agent, halo-
thane, into our regular practice. Orig-
inal investigation was carried out in

DEPARTMENT OF SURGERY

the use of a narcotic, phenazocine, this
work being reported at The World
Congress of Anesthesiologists at Tor-
onto. A study of postoperative pain
was reported at the annual meeting of
the American Society of Anesthesiolo-
gists, and a study on shock reported
before The International Anesthesia
Research Society.

Robert M. Smith, M.D.
Anesthesiologist

Bibliography

Smith, R. M., Anesthesia for emer-
gency surgery in children. Proc.
Royal Soc. Med. (In press.)

and Engineer, E. H., Problems

related to open heart operations in
children, Part I. Anes. & Anal,
39:104, 1960. Part II, Anes. &
Anal, 39:267, I960.

Smith, R. M., Stetson, J. B., and
Sanchez-Salazar, A., Postoperative
distress in children. Anesthesiology.
(In press.)

DEPARTMENT OF ORTHOPEDIC SURGERY

REPORT OF ORTHOPEDIC
SURGEON-IN-CHIEF

THE YEAR

The orthopedic service continued to
be busy in its clinical divisions, in re-
search, and in teaching. Compared
with the previous twelve months, there
were 2,000 more patient days of care
on our orthopedic divisions in the year
ending September 30, I960. The Res-
pirator Unit, too, showed an 18 per
cent increase in patient days. The aver-
age daily census of orthopedic patients
was fifty-eight, excluding orthopedic
patients in the convalescent area of the
House of the Good Samaritan. In the
orthopedic out-patient divisions, there
were 23,216 visits. This figure in-
cluded the Growth Study, the Massa-
chusetts Infantile Paralysis Clinic, and
the outside treatment clinics for polio-
myelitis. Considering only the general
orthopedic out-patient clinic and the
Massachusetts Infantile Paralysis Clinic,
there was a drop of 8 per cent in at-
tendance, largely due to the decreased
number of visits to the Massachusetts
Infantile Paralysis Clinic. The figures
for the orthopedic division of the cere-
bral palsy clinic are not included in
these figures. This clinic showed an
increase.

TEACHING

The major part of our teaching of
undergraduate students of the Harvard
Medical School affects the third year.
The schedule was revised this year, the
total hours of orthopedic instruction
for each student being increased from
33 to 45. These hours of instruction
have been arranged so that continuity
is better preserved and an increased
proportion of the instruction is pro-
vided to small groups facilitating stu-
dent participation. Both students and
instructors received the revision favor-
ably. Trauma and orthopedic diseases
of the skeletal and neuromuscular sys-
tem are forming a larger and larger
portion of medicine; expansion in in-

struction in this area is greatly needed.

RESIDENTS

Our residents are the orthopedists of
the future. They are the individuals
upon whom the progress of orthopedic
surgery depends. They will represent
the Children's Hospital Medical Center
everywhere. Our resident training pro-
gram, if not the best, is as good as any.

During the year there has been a
revision in which the program has
been expanded from three to three and
a half years in length. Residents serve
the first year at The Children's Hospi-
tal Medical Center; the second year at
The Massachusetts General Hospital.
During the first half of the third year,
all residents return to The Children's
Hospital Medical Center; in the sec-
ond half of the year, one-half the resi-
dents return to The Massachusetts
General Hospital, while the remaining
half serve in the postgraduate program
at The Children's Hospital Medical
Center, the Peter Bent Brigham, and
the West Roxbury Veterans Hospital.
In this program eight new residents
are appointed each year, two men re-
porting every three months. The can-
didates for appointment are required
to have at least two years of training
after medical school, including one
year of surgery. The present staff is
made up of eight residents in their first
year of orthopedic training, five in
their third year, and one in his fourth
year. In addition, there are one or two
residents assigned to the orthopedic
laboratory and orthopedic pathology.

Our residents are underpaid in
relation to resident salaries generally
and by all other judgments. For exam-
ple, our assistant resident, who is in
his first year of orthopedic surgery but
in his third year of training, receives
no salary at all. The residents then go
to the Massachusetts General for their
second year where they receive a mod-

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

est stipend, returning to us in their
third year to have a great reduction in
income. It is a difficult situation. Solv-
ing the problem of resident salaries
must be a top priority of the hospital.

RESEARCH

Growth and factors influencing growth
continue to be a major interest in the
department. Originally this started as
a study of the effects of poliomyelitis
upon growth of the lower extremities
but its scope has enlarged tremend-
ously. It is concerned with the causes
of abnormalities of growth, with the
prediction of growth, and the develop-
ment of methods of correcting dis-
crepancies in growth. From this has
come prediction charts that are used
everywhere and techniques which are
generally used in the correction of
discrepancies in length of the extrem-
ities. The enormous amount of longi-
tudinal data which has been collected
on the growth of the skeleton is a
subject of active investigation. It is
appropriate to pay tribute to Miss
Margaret Anderson and Miss Marie
Blais, research associates in this study,
for their stimulating participation in
this program. This work is largely
supported by a research grant from the
National Institutes of Health. Addi-
tional funds come from Noemi, United
Order of True Sisters.

Dr. Jonathan Cohen's investiga-
tions in the orthopedic laboratory have
been largely concerned with biologic
reactions to metals. This is a funda-
mental study of the tolerance of the
body to inert substances and the fac-
tors involved in their use. The causes
of failures of metals which have been
implanted in the human body are a
particular interest. Dr. Cohen and his
work arc largely supported by a grant
from the National Institutes of Health.

Dr. Henry Banks and the Chief
of the department have participated in

a continuing investigation of the value
of surgery in cerebral palsy. The con-
tributions from this study have stim-
ulated an increased interest in the use
of surgery in spastic paralysis. This
work has been supported in part by
a grant from the United Cerebral Palsy
Association. The U.C.P.A. also sup-
ports an orthopedic fellowship in this
area. In addition, Dr. Banks is study-
ing the healing of fractures of the neck
of the femur, supported in part by a
grant from the National Institutes of
Health.

Dr. Trott is concerned with the
development of artificial motors for
use in the paralytic upper extremity
and with the effect of continued heat
on growth. The first of these received
support from the National Foundation
in relation to the Respirator Unit and
the second is supported as an activity
of the Public Health Service grant on
growth.

Different members of our staff
have many other areas of investigation
and clinical research in progress. Dr.
Mihran Tachdjian has been develop-
ing objective techniques for diagnostic
evaluations in cerebral palsy; Dr. Paul
Griffin is making a study of our ex-
periences with bone tumors and their
treatment — to mention two of the
others.

Members of our department have
participated in numerous scientific
meetings and have had many national
responsibilities of various kinds. The
magnitude of these demands can be
conveyed by listing some of the activ-
ities of the Chief of Service, excluding
from this listing such things as ad-
dresses before local societies and state
meetings:

Chairman, National Committee
for the Study of Treatment of Cerebral
Palsy

Member of the Executive Com-

mittee, American Academy of Ortho-
paedic Surgeons

Member of the Advisory Council
for Orthopaedic Surgery, American
College of Surgeons

Member of the Executive Com-
mittee, American Academy for Cere-
bral Palsy

Moderator of a Panel, "Pyogenic
Infections of Bones and Joints," An-
nual Meeting of American College of
Surgeons

Instructor in the Courses of In-
struction for the American Academy
of Orthopaedic Surgeons, along with
Miss Anderson, on "Skeletal Age and
the Control of Bone Growth"

The "Honored Guest" of the
Thirteenth Congress of the Brazilian
Society of Orthopedics and Traumatol-
ogy, reading two papers — "Bone
Growth and Correction of Discrepan-
cies in Leg Length" and "The Place of
Surgery in the Treatment of Cerebral
Palsy."

In addition, the Head of the Serv-
ice participated in a symposium on
"Volkmann's Contracture" at the meet-
ing of the Brazilian Surgical Society
in Rio de Janeiro, and gave a series of
lectures at the University of San Paulo
in Brazil.

This listing illustrates the type of
responsibilities which the members of
our staff carry in areas removed from
the hospital. They require much time
but they are necessary if one properly
represents the Hospital and the Medi-
cal School.

Dr. Banks, a member of the Com-
mittee for the Study of Treatment of
Cerebral Palsy, gave an instructional
course at the meeting of the American
Academy for Cerebral Palsy on "Sur-
gery of the Lower Extremities in Cere-
bral Palsy." Dr. Cohen has been active
as a member of the Executive Com-
mittee and chairman of the Program
Committee of the Orthopaedic Re-

DEPARTMENT OF ORTHOPEDIC SURGERY

search Society, and was a participant
in the Gordon Conference.

STAFF

Dr. Albert H. Brewster and Dr.
Robert Morris, long senior members
of our staff, were promoted to Ortho-
pedic Surgeon, Emeritus, after many
years of service to the Hospital. The
Hospital is indebted to them. They
gave much to it over the years and
we miss their active participation.

In July 1959 Dr. Paul Griffin,
after an outstanding performance as
Chief Resident, joined the staff as As-
sistant Orthopedic Surgeon. Dr. Rob-
ert Brownhill succeeded him as Chief
Resident and also did an excellent job.
Dr. Brownhill, after completing his
residency in June of I960, joined the
orthopedic staff of Baylor University
in Houston, Texas. Dr. Charles F.
Heinig in turn succeeded him. In
January of I960, Dr. Mihran Tachd-
jian was appointed to the staff as As-
sistant in Orthopedic Surgery. Dr.
Tachdjian, a graduate of the American
University of Beirut, had his training
in surgery and orthopedic surgery in
the Chicago area in the Northwestern
University program. He then became
associated with Dr. Edward Compere,
Professor of Orthopedic Surgery at
Northwestern and in the Armed Serv-
ices. He has had a brilliant record
wherever he has been. We are pleased
to welcome Dr. Griffin and Dr. Tachd-
jian to our staff.

Our staff has worked at full
capacity throughout the year. In cer-
tain areas it has been overextended in
its responsibilities and would be more
productive if it were not so busy. The
only area that has suffered is research.
Considering that our staff provides the
teaching and clinical supervision of
orthopedic surgery at the Peter Bent
Brigham and the West Roxbury Vet-
erans Hospital, it becomes apparent

that it has much to do. A busy staff is
a healthy staff but fewer clinical de-
mands would lead to greater produc-
tivity. Plans are underway for its ex-
pansion.

More and more in the changing
pattern of medicine, an endowed chair
in a department such as ours becomes
essential if it is to carry out its work
in the best possible way and contribute
most to the field. Under the present
arrangement, the Chief is primarily
responsible for support of the depart-
ment, although the Hospital has been
of great assistance. Income from the
practice of orthopedics is the primary
source of support. It seems essential
to the future that an endowed profes-
sorship at Harvard Medical School be
established in this hospital with pro-
vision also being made for the support
of other positions in the department
so that greater stability and depth of
staff can be established.

POLIOMYELITIS

One of the major changes affecting our
department has been the decreasing
number of cases of poliomyelitis. The
annual incidence has been much re-
duced since the severe epidemic of
1955, in which there were more cases
of poliomyelitis in Massachusetts than
in any previous year. It is the natural
epidemiologic characteristic of the dis-
ease to have few cases for several years
after a big epidemic such as we had
in 1955 but a major factor in the
lower incidence is the use of the Salk
vaccine. This vaccine has not given
an absolutely dependable immunity
from the paralytic disease but it cer-
tainly has had a major inhibiting ef-
fect. One may expect poliomyelitis to
show a decreasing trend so that it is
no longer a serious threat. This ex-
pectation must be a part of our plan.

The treatment of the acute dis-
ease and convalescence were not prob-

lems in the past year but the patients
who have had the disease in prior
years still remain a major concern.
They require medical care, they re-
quire surgery, and general measures of
rehabilitation. They will require help
for many years. A child who has any
significant degree of paralysis needs
supervision until he is grown and
some care is indicated after that. Pro-
viding for the care of these individu-
als has suddenly become more difficult
in that there has been a major change
in the financial aid which is available
for patients with poliomyelitis.

As a background, it seems appro-
priate to review the relation of this
hospital to the treatment of polio-
myelitis over the years. This hospital,
in fact, has had a distinguished his-
tory in this field. Many of those who
have contributed most to knowledge
regarding this disease and its treat-
ment have been members of this staff
over the years, beginning with Dr.
Robert W. Lovett, the Chief of Ortho-
pedic Surgery from 1912 to 1922.

In 1916 Dr. Lovett was largely
instrumental in forming the Harvard
Infantile Paralysis Commission, or-
ganized at the time a large epidemic
created a panic of fear and apprehen-
sion in Massachusetts and in New
York. The Commission was formed
for the care and investigation of an-
terior poliomyelitis. Its original clinic
was located at Children's and this
clinic has been maintained continu-
ously since that time. The director of
the clinic has always been a member
of the orthopedic staff here at the
Children's Hospital. As a part of this
program, in addition to the central
clinic, there have been regular treat-
ment clinics held in various outlying
cities and towns over the years, all
conducted by the Children's staff.

In 1946 Harvard Medical School,
as a part of a move in which it

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

severed all direct relations with the
care of the patients, asked that the
auspices of the Harvard Infantile
Paralysis Clinics be transferred to the
Hospital if this was possible. Ac-
cordingly, in that year the clinics be-
came the Massachusetts Infantile
Paralysis Clinics of the Children's
Hospital. Under this title the Clinics
have continued to thrive under the
same organization and plan over the
years. Outside treatment clinics are
still held in Beverly, Dedham, Haver-
hill, Lawrence, Lowell, Maiden, Med-
ford, Quincy, Somerville, and Wal-
tham. The organizational plan was one
which has been copied widely since it
provided a continuity of care in
chronic disease and made maximal use
of skilled personnel in caring for such
a disease. There have been only three
directors of the clinics since 1916 —
Dr. Lovett, Dr. Arthur Legg, and Dr.
William T. Green.

In addition to many contributions
in the total field of poliomyelitis, the
Clinics have a particular relation to
education in poliomyelitis and prob-
lems created by epidemics over the
country. In collaboration with the Na-
tional Foundation, Children's Hospital
maintained for many years a Poliomye-
litis Emergency Unit. This unit was
called to many areas during devastat-
ing outbreaks to give temporary help
and organize local groups in the care
of the disease. On one occasion dur-
ing the second World War the unit
was sent to Germany when an
epidemic arose affecting the Armed
Services in that area. For many years
two postgraduate courses a year, of a
week's duration, were given for physi-
cians, instructing them in the treat-
ment of poliomyelitis. These courses,
along with annual courses for nurses
and for physical therapists, were fos-
tered by the National Foundation,

which provided appropriate scholar-
ships.

Originally the Harvard Infantile
Paralysis Commission had an annual
drive to support the Clinics. These
were well received and supported. In
1940 New England Chapters of the
National Foundation asked the Har-
vard Infantile Paralysis Clinics to de-
sist from raising funds to support the
Clinics since, they said, it interfered
with their fund raising; they indicated
that they would support the Clinics.
Accordingly, after many conferences,
an agreement evolved in which the
Chapters of the National Foundation
agreed to support the Clinic, based on
its annual budget in relation to the
number of patients treated during the
year. The per capita cost was deter-
mined and each Chapter agreed to
support the cost of care of the patients
from their county. This was adopted
in 1940 but it was not until 1944 that
it became a reality. This was done on
an annual basis and worked out as an
efficient and pleasant arrangement
over a 15 -year period, both to the
Chapters and to the Clinic.

Last year, however, the Chapters
had increasing difficulty in meeting
their payments. By July 1, 1959, they
indicated that they were no longer in
a position to pay for braces or other
apparatus except under unusual cir-
cumstances. In January they indicated
that they were no longer able to main-
tain their former financial support of
the Clinics. Prior to this, as far back
as 1916, no charge had been made to
the patient for clinic service. During
this time it had been self-supporting
except for the space provided by the
Children's Hospital. Any remodeling
of the area had been provided by
Clinic funds.

It was necessary, therefore, on
April 1, I960, to institute charges for
visits and for physical therapy in the

Clinic. For many patients of the
Clinic this has been a difficult change,
particularly if they have had expensive
apparatus to purchase and maintain.
In addition to the problems of patients
who are unable to pay, there has been
considerable reaction to the new situa-
tion by other patients and their fami-
lies, inasmuch as they had been accus-
tomed to receiving this service without
charge.

This changed relation of the Na-
tional Foundation to the support of
poliomyelitis has also cast its shadow
upon the patients who need hospital
admission for surgery and other care.
No longer does the Foundation freely
underwrite the costs. In fact, a con-
siderable amount is still due the hos-
pital and the clinics for medical care
during 1958-59. This changed relation
in the National Foundation has arisen
in part from the fact that the Founda-
tion has broadened its base of interest
and extended it to include other dis-
eases. More than this, however, is the
fact that it did not have sufficient
funds in I960 to meet its obligations.
In the meantime, the problems of the
patients who have had poliomyelitis
and need care and rehabilitation re-
main with us.

It is well to say, however, that
the National Foundation does still aid
the Respirator Unit to the extent of
an annual grant of $54,434. For this
we are most grateful. Even here, how-
ever, the problems of hospitalization
arise in that formerly the Chapters of
the National Foundation gave addi-
tional support for the care of patients
from their Chapter by paying a per
diem charge. This is no longer avail-
able in most instances.

THE COST OF CARE

The changing pattern of support in
poliomyelitis stimulates other com-
ments regarding the cost of patient

DEPARTMENT OF ORTHOPEDIC SURGERY

care. Hospitalizations for the treat-
ment of the crippled child are likely
to be longer than for many other types
of illness. The increasing cost of medi-
cal care and the decreasing proportion
of these costs that are met by income
from endowed funds compound this
issue. The increased numbers of pa-
tients whose hospitalization is covered
by plans of voluntary insurance has
been a big factor in meeting a part of
this problem. Even where coverage
exists, however, it is likely to be only
partial in its extent. Support from
additional sources is needed.

One program that has been of
great assistance over the years in pro-
viding help to the crippled child and
to the hospital in its care for such a
child has been the Massachusetts
Crippled Children's Services. Many of
the members of our orthopedic staff
are consultants for this program and,
as consultants, hold monthly clinics
for the Commonwealth in various
parts of the State. In turn, the ma-
jority of the patients from these par-
ticular clinics are admitted here at the
hospital for their surgery or for other
care. The Crippled Child's program
underwrites the cost of care and the
hospital, in turn, helps the State pro-
vide for effective, efficient medical
care at a minimal cost provided all
factors are considered. The patients
are treated in the environment of a
teaching program, which not only pro-
vides the best of care to the patient
but also provides for the values of ob-
servation and education of the student
and resident as well.

The Crippled Children's Service
supports the cost of hospitalization of
these patients but does not pay medi-
cal fees for surgery or for medical
care. It does provide a fee for the
actual conduct of monthly outside
clinics. This is an arrangement which
we hope will continue to be fostered

by the Commonwealth and by the
Hospital. The Crippled Children's
Services are under the Commissioner
of Health and the immediate direc-
tion of Dr. Janice Rafuse. Our Serv-
ice is privileged to participate in this
program.

Such support aids the hospital
immeasurably in providing a strong
program for the handicapped child
which, in turn, is available to all our
citizens whether they are in the State
program or not. If this care comes to
be provided more and more by state
institutions, it will greatly weaken the
care of the crippled child not falling
under the aegis of a state program. I
believe it is most important that the
present arrangement be preserved and,
indeed, expanded. Certainly the plan
existing in certain states and counties
to assist voluntary hospitals in pro-
viding care through governmental aid
has much to be said for it.

We are convinced that, one way
or another, increasing assistance will
arise. New programs are arising.
Whatever the source, we must be pre-
pared to provide the service which
merits support.

Basically, if the hospital had in-
creased endowment, many of our prob-
lems would be solved. It is proposed
that deficits arise because our percen-
tage of occupancy is not high enough.
In fact, one of the factors reducing our
occupancy, as far as the crippled child
is concerned, is the cost of care. If
the hospital's endowment were suffi-
cient to aid these patients in meeting
their costs, the problems of occupancy
and, indeed, the deficit would be an-
swered together. Fundamentally, a
hospital such as ours will always have
a deficit if it is carrying out its duties
to the full. It is only by increasing
endowment income, special funds, and
support by programs assisting in the

cost of medicine that we can remain
solvent.

BUILDING

The John Wells Farley Memorial
Building has given us excellent fa-
cilities for the care of the in-patient.
In fact, if we were asked to recom-
mend new accommodations for our
orthopedic patients, we would be hard
put to improve upon the present plan.
The wards are well arranged. The
children of various ages can be
grouped as they should be. A plaster
room on the division has proven to
be a most effective arrangement. The
close relation of the functional train-
ing room and physical therapy, all
combine to make this a very satisfac-
tory unit.

By contrast, our out-patient clinic
leaves much to be desired. The pres-
ent facilities are unattractive, crowded,
and poorly arranged. They have little
appeal to the patient and make work
difficult. In the shifting pattern, am-
bulatory services become a larger and
larger part of medicine. Many of the
conditions which were formerly
treated in the hospital through long
stays can now be treated in the clinic.
The outpatient clinic, too, is the area
where a hospital meets a large part of
its public. It should be able to greet
them well. This our hospital cannot
do under the present circumstances. A
new ambulatory clinic area is greatly
needed.

Another great need for space is
in the area of research. It is quite es-
sential to our department that our re-
search activities be increased. Our de-
partment has been the recipient of
certain gifts of funds which give us a
certain amount of hard-core support
for increasing activity. We are striv-
ing to increase this amount. With the
increasing availability of support
from research grants, our research ac-

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

tivities can and should be expanded.
Our laboratory areas are confined to
the Growth Study area, on the sixth
floor of the Bader building, and to a
laboratory in the Jimmy Fund build-
ing, available to us through the good
offices of the Cancer Research Founda-
tion and Dr. Farber. We do have a
small laboratory, the Saltonstall Lab-
oratory, on the second floor of the
Farley Building. At the present time
it is being used largely by the depart-
ment of cardiology, which was in
great need for space close to X-ray.
Since we had the space in the Jimmy
Fund Building, we were able to free
a part of the second floor laboratory
room temporarily for their use.

Expansion of research is essential
to the health of our department and
with it more space is necessary. It is
our conviction that a building housing
ambulatory clinics and research labora-
tories is a pressing need of the
hospital.

VOCATIONAL GUIDANCE

As the Hospital increased the age of
the children for which it is respon-
sible, the need for vocational guidance
of the handicapped child assumes
greater and greater importance. If
we provide maximal services for the
handicapped child, it is important
that he be directed into that vocation
for which he is best suited. This
means a combined assessment of his
physical condition and the limitations
imposed by his mental and emotional
aptitudes. For example, in the patient
with severe poliomyelitis, one can de-
termine quite accurately what the par-
ticular child will be able to do physi-
cally when he is an adult. It is
important to weigh all the factors
which determine his potentialities. If
this is done at a reasonably young age,
one can guide his education, his inter-
ests, and provide training in the field

in which he can be most productive
and most happy.

Over the last two years our de-
partment has fostered, with the Bay
State Society, a guidance clinic which
meets one day a week. The Bay State
Society provided a very capable coun-
selor, Mr. Richard LaPierre, and the
clinic has been held in relation to the
Massachusetts Infantile Paralysis
Clinic area. This has been a pilot
study, with most of the patients com-
ing from the Infantile Paralysis Clinic,
but it has indicated the values of such
a service. An attempt has been made
to get special funds to support this
activity, but, so far, they have not be-
come available. We need to expand
our efforts in this area. There is a
great need to supply better guidance
to the growing handicapped child so
that he may attain his maximal place
in society.

A list of publications from the
department is appended.*

William T. Green, M.D.
Orthopedic Surgeon-in-Chief

*We wish to thank all those who
have made gifts to the department
during the year, including the Ziskind
Foundation, the Fuller Foundation, the
Probonata Club, Dr. Howard K. Mor-
rison, Mr. and Mrs. Eben Phillips, Mr.
and Mrs. David Ross, with a special
place for Noemi U.T.O.S. who year
after year provide special support
when it is needed. Finally, the Chief of
Service wishes to express his appre-
ciation for the loyal efforts of the
Staff, the residents, the nurses, the
physical therapists, the secretaries of
the Department, and, indeed, for the
support of the administration and
trustees, and all others who have made
this year what it has been.

Bibliography

Anderson, M., and Green, W. T., The
femur and tibia: growth and pre-
dictions of growth in later child-
hood. (In preparation.)

Banks, H. H, and Green, W. T., Cor-
rection of equinus in cerebral palsy.
In Yearbook of Orthopedics and
Traumatic Surgery, 1959-60.

, Adductor myotomy and ob-
turator neurectomy for the correc-
tion of adduction contracture of the
hip in cerebral palsy. /. Bone Joint
Surg., 42 A -All, I960.

, Correction of hamstring con-

tracture in cerebral palsy. (In prep-
aration. )

Cohen, J., Simple bone cysts. /. Bone
Joint Surg., 42/4:609, I960.

and Foultz, W. S., Failure by

corrosion of a Steinman pin. /. Bone
Joint Surg., 42AA201, I960.

Cohen, J., and Maletskos, C J., Ca 45
in the study of bone grafts in dogs.
Proceedings, Symposium of Inter-
national Society of Traumatology
and Orthopedic Surgery, I960.

Cohen, J., and Sledge, C. B., Diastema-
tomyelia. Am. J. Dis. Child., 100:
257, 1960.

Cohen, J., and Weinfeld, M. S., Ex-
perimental excision of muscles in
the weanling rat. /. Bone Joint
Surg., 42A:278, I960.

Green, W. T, and Anderson, M.,
Skeletal age and the control of bone
growth. In Reynolds, F. E. (Ed.),
Instructional Course Lectures, Amer-
ican Academy of Orthopaedic Sur-
geons, 17:199. Mosby, I960.

Green, W. T., and Banks, H. H, Cor-
rection of adduction-flexion, internal
rotation of the hip in cerebal palsy.
/. Bone Joint Surg., December 1959.

Hilding, D. A., and Tachdjian, M. O.,
Dysphagia and hypertrophic spur-
ring of the cervical spine. N. E. J.
Med., 263:11, I960.

Marshall, J. H, White, V. K, and

Cohen, J., Autoradiography of serial
cross sections of undecalcified bone.
Rod. Res., 10:197, 1959.
Quigley, T. B., and Banks, H. H.,
Medical progress, treatment of frac-
tures and dislocations, 1950-1960.
N. E. J. Med., 263:344, I960. 263:
391, 1960. 263:444, I960. 263:
493, 1960.

DEPARTMENT OF ORTHOPEDIC SURGERY

DEPARTMENT OF NEUROSURGERY

REPORT OF
NEUROSURGEON-IN-CHIEF

Since its organization as a separate
unit in the early 1930s, the Neuro-
surgical Service has grown steadily.
Like other departments of the Chil-
dren's Hospital Medical Center, it
serves a two-fold function; namely, as
a community hospital (in the greater
Boston area) ministering to children
with head injuries, infections, congeni-
tal anomalies and neoplasms and, sec-
ondly, as a referral and consultation
service for specialized and complicated
problems of pediatric neurosurgery
from all over the world.

The influence of the Service has
spread widely as a result of publica-
tion, in 1954, of the first textbook
devoted to pediatric neurosurgery.
This text, Neurosurgery in Infancy and
Childhood, by Franc D. Ingraham and
Donald D. Matson, is now out of
print; its revision is one of the tasks
which must be fitted in the program
of the next few years. The influence
of the Neurosurgical Service also has
been extended by men who have re-
ceived special training in childhood
neurosurgery here, and gone on to
practice and teach in other centers in
the United States and Canada.

As a center for surgery and for
training young men in this special
field, the Neurosurgical Service of the
Children's Hospital Medical Center is
closely affiliated with that of the Peter
Bent Brigham Hospital. Its four-year
training program is approved by the
Council on Medical Education and
Hospitals of the American Medical
Association and the American Board
of Neurological Surgery. In addition
to the staff men with regular appoint-
ments in the clinics or laboratories
service, the Hospital receives a steady
stream of visitors from neurosurgical
centers throughout the world inter-
ested in the organization and function
of this unit.

In addition to taking part in the

combined rounds and clinical patho-
logical conferences of the whole Hos-
pital, the Neurosurgical Service holds
the following teaching conferences:
monthly neuroradiology, bimonthly
microscopic neuropathology, bi-
monthly brain-cutting, monthly elec-
troencephalography, and monthly spe-
cial conferences in neurology, lab-
oratory investigation, or related fields.

One of the principal interests of
the Neurological Service for many
years has been the study of the normal
circulation of cerebro-spinal fluid and
the clinical treatment of various forms
of hydrocephalus. Diversion of spinal
fluid from the sub-arachnoid spaces
into the urinary tract by modern
methods was devised and first used
by this Service in 1948, and has since
had wide-spread use throughout the
world. The newer types of shunting
operations also have been continually
investigated and employed.

This Service has defined a variety
of congenital conditions involving the
nervous system either primarily or
secondarily, and has developed tech-
niques for surgical treatment. In
addition to the treatment of certain
types of hydrocephalus, these include
procedures for premature closure of
the cranial sutures, congenital dermal
sinus tracts, diastematomyelia, spina
bifida and such congenital tumors as
papillomas of the choroid plexus and
craniopharyniomas. The value of
ACTH and cortisone as supportive
treatment during surgical management
of these latter tumors was first stressed
in a paper from this Service in 1952.
Results in afflicted children have vastly
improved as a result of the cooperative
efforts of the Endocrine and Neuro-
surgical Services.

The recognition and prompt
treatment of neurological complica-
tions of congenital heart disease, par-
ticularly brain abscess, have been a

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

special interest of the Neurosurgical
and Cardiology Services in recent
years. Many of these complications,
previously almost invariably fatal, have
been managed successfully with a
combination of neurologic and cardiac
surgery and intensive antibiotic
therapy.

With construction of the new op-
erating rooms, adequately shielded
equipment made possible careful op-
erating room electrocorticography in
the study and treatment of children
with various types of epilepsy. Surgi-
cal results have been most gratifying
in well-selected cases.

Another recent interest of the
Neurosurgical Service has been in
cerebrovascular diseases, or "strokes,"
in childhood, a hitherto largely un-
explored field. The possibility of sur-
gical treatment of arterial occlusion,
both of extracranial and intracranial
vessels is being studied, particularly
by Dr. John Shillito. This work is
supported in part by a National Heart
Institute grant, now in its second year.

The clinical work of the Neuro-
surgical Service, as well as the training
of men in the resident staff, has been
significantly improved by the ima-
ginative, careful, and provocative help
of Dr. Betty Banker and her associates
in the Neuropathology Division of
the Pathology Department; it is hoped
that the work will continue to be ex-
panded.

THE FUTURE

What of the Future? There are many
standard neurosurgical clinical prob-
lems, such as those dealing with
trauma, certain of the congenital mal-
formations, infection, and benign tu-
mors, that the Service will continue to
attack and manage with the most
careful clinical judgment and surgical
skill possible. There are many areas
in the field of pediatric neurological

surgery that remain to be developed.
Certainly the treatment of the com-
mon gliomas of the brain has shown
little progress in the last thirty years.
The search continues for means of
establishing differential uptake of a
toxic chemical or radioactive agent in
tumor as compared with normal brain
tissue of sufficient degree so that an
infiltrative tumor might be destroyed
without similar destruction of the
host's cerebral tissue. The application
of intermittent or continuous perfu-
sion techniques to temporarily isolated
cerebral circulation to achieve higher
concentration of cytotoxic agents in
the tumor may contribute to this goal.
Complete cessation of circulation to
the brain for periods long enough to
carry out complicated surgical proce-
dures on vascular malformations and
vascular tumors would seem to be pos-
sible in the not-too-distant future
under conditions of safe, profound
hypothermia. Newer and better meth-
ods to treat obstruction to spinal fluid
circulation must be devised. Neuro-
surgical measures in the treatment of
involuntary tremor, spasms, and con-
vulsive seizures seem certain to im-
prove with further refinement of elec-
trophysiological and stereotoxic meth-
ods. Understanding of neuro-
endocrine mechanisms will un-
doubtedly be improved by work in
both the laboratory and in the clinic.

OPERATIONS

The following tabulations reflect the
activities of the Neurosurgical Service
in the past year:

ADMISSIONS — 517

Congenital Anomalies 193

Infections 24

Intracranial Tumors 50

Spinal Tumors 6

Trauma 126

Miscellaneous 118

Total TiT

Private
Staff
Total

opd visits — 1188
Average number of
patients per clinic

DIAGNOSTIC PROCEDURES
Pneumoencephalograms
Ventriculograms
Myelograms
Arteriograms
Burr Holes alone
Burr Holes and

Ventriculograms
PEG and Arteriograms
Total

OPERATIONS — 458
Laminectomies

Spinal Tumors

Discs: Lumbar
Cervical

Abscess

Pain Control

Total

CRANIOTOMIES
Brain Tumors
Subdural Hematoma

and Membranes
Vascular Disease
Abscess
Pain Control
Head Injuries
Epilepsy
Other

Total

OTHER

Brain Biopsy
Excision

Porencephalic Cyst
Posterior Fossa

Decompression
Posterior

Lysis of Adhesions
Posterior

Excision of Cyst

161
356
~517~

22.84

53
47
14
29

170

17
7
1

5
2

DEPARTMENT OF NEUROSURGERY

Posterior

Exploration of V-C shunt 1

Evacuation Epidural

Hematoma 1

Repair, CSF Leak 4

Exploration, only 1

Total 18

DERMOID CYSTS

Intracranial 2

Cranial 8

Spinal 1

Total if

Cranioplasties 2

Craniectomies 30

Meningoceles 1 1

Encephaloceles

Skull Fractures 1 1

Peripheral Nerve Suture 4
Other Peripheral

Nerve Surgery 5

Total 63

SHUNTS

Ventriculo-cervical

Ventriculo-ureteral 6

Ventriculo-peritoneal 2

Lumbar-ureteral 5

Lumbar-peritoneal
Insertion of CSF Valve

(V-J shunt) 34

Subdural-peritoneal 1

Torkildsen Procedure
Revision or removal

of shunt 54

Total T02

MISCELLANEOUS

Repair, pseudo-meningocele 2
Repair, CSF Leak
Carotid Artery Exploration
Debridement and Partial

Craniotomy, Osteo
Excisio, hamangioma of scalp
Excision, hairy nevus
Carotid perfusion
Secondary wound closure
Removal, varix of scalp
Excision, A-V malformation

Radical excision tumor, eye 1
Excision, tumor of forehead 1
Repair, surgical skull defect 1
Biopsy, dura and frontal sinus 1
Skin graft, upper eyelid 1

Total ~2\

STAFF ACTIVITIES

Dr. Robert W. Schick, who became
Chief Resident of the combined Chil-
dren's Hospital Medical Center-Peter
Bent Brigham Hospital Neurosurgical
Service on July 1, 1959, left the Cen-
ter on December 31, I960, to begin
practice in New York City with staff
appointments at St. Luke's and Belle-
vue Hospitals and the Neurosurgical
Department of Cornell Medical School.
Dr. John T. Garner, who had been
Assistant Resident in Neurological
Surgery since September 1, 1959,
moved up to Chief Resident on Janu-
ary 1, 1961.

On July 1, I960, a third resident,
Dr. Francis X. Rockett, was added to
the Neurosurgical Service. He is a
graduate of Harvard Medical School,
with previous training in surgery at
Boston City Hospital and two years
of service in the Navy.

It is now planned that each ca-
reer neurosurgical trainee will remain
three years on the combined Chil-
dren's Hospital Medical Center-Peter
Bent Brigham Hospital Neurosurgical
Service, serving successively as Junior,
Senior and Chief Resident. During the
first year the Resident's work will be
primarily in immediate supervision of
the large neurosurgical ward at The
Children's Hospital Medical Center
with help in coverage of procedures
and clinics at the Peter Bent Brigham
Hospital and participation in all the
various teaching exercises and confer-
ences. In the second year the Resident
will advance in responsibilities in both
hospitals and will cover the Peter Bent
Brigham Hospital surgical house offi-

cer rotating through the Neurosurgi-
cal Service.

On June 30, I960, Dr. James T.
Robertson finished a year as Clinical
Fellow in Neurosurgery and entered
the Air Force. He is now Assistant
Chief of Neurosurgery at Travis Air
Force Base, California. During the
year Dr. Robertson read papers at the
American Academy of Neurology and
the New England Neurosurgical So-
ciety, and collaborated on reports pub-
lished in the Journal of Neurosurgery
and Pediatrics.

Dr. Nurhan Avman, one of the
Research Fellows during the past year,
has returned to Ankara, Turkey, to
head the Department of Neurosurgery
at the University of Ankara.

Dr. Matson has continued as Sec-
retary of the American Board of
Neurological Surgery. He was also a
member of the ad hoc committee of
the National Institute of Neurological
Diseases and Blindness to consider
policy regarding training grants in the
field of neurosurgery and has subse-
quently been appointed to the Ad-
visory Committee of the National
Institute of Neurological Diseases and
Blindness for a four-year period.

PAPERS PRESENTED AT
NATIONAL SOCIETY MEETINGS

American Academy of Neurology,
Miami Beach, Fla.

American Academy of Neurological
Surgery, Pebble Beach, Cal.

American College of Surgeons, Atlan-
tic City, N. J.

American Academy of Pediatrics,
Chicago, 111.

American Surgical Association, White
Sulphur Springs, Va.

American Neurological Association,
Boston, Mass.

Harvey Cushing Society, San Fran-
cisco, Cal.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Protein Foundation, Cambridge, Mass.
Scandinavian Neurosurgical Society,
Lund, Sweden.

Post-Graduate Teaching Programs
participated in:

New Orleans Graduate Medical As-
sembly

Mid-South Post-Graduate Assembly,
Memphis

Houston Neurological Society

12th Annual Pediatric Institute for the
General Practitioner, Portland, Me.

Other Meetings Attended:

Congress of Neurological Surgeons,

Miami, Fla.
Neurosurgical Society of America,

Pebble Beach, Cal.
Society of Neurological Surgeons,

Seattle, Wash.
American Pediatric Society, Swamp-

scott, Mass.

NEUROSURGICAL RESEARCH
LABORATORY

In this first full year since the renova-
tion of the Neurosurgical Research
Laboratory there has been a consider-
able increase in activity, although
much of the equipment had to be in-
stalled and the interior work com-
pleted in the early months.

The work of the laboratory has
centered on two main projects: a con-
tinuing one on the physiology of cere-
brospinal fluid and the other on hypo-
thermia, physiology of the body under
lowered body temperatures. In addi-
tion, a project on the pressure in the
cerebral circulation, based on a model
of the blood vessels, was carried out.

The use of urea in conjunction
with hypothermia was extensively
studied during the year. This work
was carried out in dogs over a tem-

perature range of 37°-24°C, and hy-
pertonic urea solutions were given to
the cooled animals. Studies were made
of the elimination of urea from the
body, the mixing of urea with the cere-
brospinal fluid, the exchange of osmotic
equilibrium between the blood cere-
brospinal fluid, the urinary output, and
changes which occurred in the electro-
lyte composition of the blood and the
cerebrospinal fluid following the in-
jection. It was demonstrated that the
pressure changes effected by the urea
depended upon the osmotic pressure
gradient between the serum and cere-
brospinal fluid, and this was independ-
ent of any urinary output. The return
of the serum osmotic pressure to nor-
mal at normal temperatures was a
function of the elimination of urea by
kidneys, but when the body tempera-
ture was lowered below 30°C, this
return to normal was accomplished by
the elimination of salt as well. This
is an extremely important observatioa
When this procedure is used in the
clinic, great attention must be paid or
serious conditions of low salt are likely
to result. It was also determined that
a smaller dose of urea was required to
achieve the same effect at low body
temperature.

During the latter part of the
year, attention was devoted to work
on deep hypothermia and hypothermia
combined with extracorporeal circula-
tion. This work was designed to ex-
plore temperatures below 20 °C and as
yet has not produced enough data to
warrant a report.

Conclusive results in hypothermia
also have been obtained in definite
studies demonstrating that the metabo-
lism of the brain is not a linear func-
tion of temperature, and that oxygen
is used by the brain at all tempera-
tures.

Studies on the cerebrospinal fluid
were centered on the production of

cerebrospinal fluid in the dehydrated
state. This has long been known to be
a condition in which intracranial pres-
sure was decreased and cerebrospinal
fluid was produced at decreased rates.
It was felt that the study possibly
would yield detailed information on
the minimum quantities of cerebro-
spinal fluid produced and the events
associated with it. This work, carried
out on dogs, demonstrated that in the
dehydrated state the critical and con-
trolling factor in the production of
cerebrospinal fluid was the arterial
blood pressure, and that there is a di-
rect relationship between the arterial
blood pressure and the cerebrospinal
fluid production. This observation has
suggested that there is a minimum
amount of cerebrospinal fluid which
will be produced by the hydrostatic
forces of the cerebral blood flow, and
it is this minimum which must be re-
moved in order to prevent hydrocepha-
lus from developing. It further demon-
strated that there was no relationship
between cerebral metabolism and cere-
brospinal fluid production in the de-
hydrated state, which is in contrast to
the normal animal, whether it be
hydrocephalic or not.

Other experiments on the osmotic
pressure of the cerebrospinal fluid
show that the old concept of the total
osmotic pressure of the cerebrospinal
fluid being equal to that of the serum
is probably wrong and that the cere-
brospinal fluid is probably higher than
the arterial blood by several mille-
simals with the cerebral venous blood
somewhere in between. This finding
has been confirmed from studies on
the intracranial pressure changes
which seem to be a function of
osmotic pressure. It has been found
that the zero pressure change occurs
when the cerebrospinal fluid is slightly
above that of the blood.

All these experiments, combined

DEPARTMENT OF NEUROSURGERY

with those of the previous years, are
being synthesized into a general de-
scription of the cerebrospinal fluid
formation which suggests that there
are two important physical factors in-
volved in the bulk and formation of
cerebrospinal fluid: filtration by the
blood and a movement of fluid second-
ary to osmotic pressure changes. Super-
imposed on these are the metabolic
processes continually in action which
function to keep the cerebrospinal
fluid pressure composition constant.

The other major project of the
year was the construction of a model
of the Circle of Willis and the arteries
leading to it, using plastic tubing. The
size and length of the various vessels
were taken from the standard anatomi-
cal texts, and a Sigmamotor pump was
used to pump blood or fluid through
the system. The peripheral vessels
were given an added resistance so that
the blood flow and pressure through
the system was consistent with that of
a normal adult. Various vessels were
occluded and pressure measurements
made beyond them and in the Circle
of Willis to show the effects of these
occlusions. Particularly important were
the observations made on the vertebral
arteries where very few have been
made clinically. This work demon-
strated that before occlusion of a verte-
bral artery is carried out in the clinic,
bilateral angiograms should be made
in order to decide which vessel should
be occluded.

In another series of experiments
in the realm of hypothermia it was
shown that while occlusion of the total
circulation of the brain can only be
tolerated for 15 minutes, the middle
cerebral artery could be occluded for
as long as 45 minutes if the body
temperature was at 25 °C. This find-
ing is similar to results at normal
temperature where the middle cerebral
artery can be occluded for periods

slightly longer than the total brain can
withstand circulatory arrest. The rea-
sons for this are not clear, but it was
suggested that the small amount of
circulation through the collaterals
tends to remove metabolic products,
possible C0 2 which allows a longer
period of survival.

Franc D. Ingraham, M.D.
Neurosurgeon-in-Chief

Bibliography-
Bering, E. A., Jr., Cerebral spinal fluid
production and its relationship to
cerebral metabolism and cerebral
blood flow. Am. J. Physiol., 197:
825, 1959.

, Preliminary studies of the

temperature coefficient of blood
clotting. Vox Sanguinis, 3: 82, I960.
Crofton, F. D. L, and Matson, D. D.,
Roentgenological study of choroid
plexus papillomas in childhood. Am.
J. Roent., Rod. Therapy & Nuclear
Med., 83:479, I960.
Ingraham, F. D., and Bailey, O. T.,
Cystic teratomas and teratoid tumors
of the central nervous system in in-
fancy and childhood, Part II. /
Neurosurg. (In press.)

Ingraham, F. D., and Matson, D. D.,
Tumors of the central nervous sys-
tem. In Cancer and Allied Diseases
of Infancy and Childhood. Little
Brown, I960.

Jessiman, A. G., Matson, D. D., and
Moore, F. D., Hypophysectomy in
the treatment of breast cancer. N.
E.J.Med. 261:1199, 1959.

Matson, D. D., Comparison of bio-
logical behavior of intracranial tu-
mors of children and adults. Trans.
Am. Neurol. Assoc, I960. (In
press. )

, Congenital anomalies of the

nervous system. In Davis, L. (Ed.),
Christopher's Textbook of Surgery,
7th ed. Saunders, I960.

-, The management of acute

compound battle-incurred injuries
of the spinal cord. In Surgery in
World War II, Neurosurgery, Vol.
2. Office of the Surgeon General,
Department of the Army, 1959.
-, Surgical treatment of congen-

ital anomalies of the coronal and
metopic sutures. /. Neurosurg., 17:
413, I960.
and Crigler, J. F., Radical

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

treatment of craniopharyngioma.
Ann. Surg. (In press.)

Matson, D. D., and Crofton, F. D. L.,
Papilloma of the choroid plexus in
childhood. J.Neurosurg. (In press.)

Matson, D. D., and Robertson, J. T.,
Therapeutic agents for reduction of
intracranial pressure. Pediatrics, 25 :
73, I960.

Robertson, J. T., Schick, R. W., Mor-
gan, R, and Matson, D. D., Ac-
curate placement of ventriculo-atrial
shunt for hydrocephalus under elec-
trocardiographic control. /. Neuro-
surg. (In press.)

Selenkow, H. A., Tyler, H. R., Matson,
D. D., and Nelson, D. H., Hypo-
pituitarism due to hypothalamic
sarciodosis. Am. ]. Med. Sci., 238:
456, 1959.

Shillito, J., Jr., Indications for surgery
in cerebrovascular accidents. P. G.
Med. (In press.)

Uzman, L. L., Bering, E. A., Jr., and
Morris, C. E., Neuraminic acid con-
tent of cerebrospinal fluid as af-
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Clin. Invest., 38:1756, 1959.

DEPARTMENT OF PSYCHIATRY

REPORT OF
PSYCHIATRIST-IN-CHIEF

INTRODUCTION

Although this report was limited orig-
inally to review of the structure, func-
tions, and needs of the Child Psychia-
try Department of The Children's
Hospital, it soon became apparent that
such an approach would give a rather
circumscribed and narrow view of the
treatment, training, and research ac-
tivities relative to child mental health
that are established and expanding in
the Medical Center as a whole. The
coordination of these activities in the
Department proper with the allied or
parallel activities going on in (a) the
affiliated Judge Baker Guidance Cen-
ter, plus the teaching programs in
association with (b) the Harvard
Medical School Department of Psy-
chiatry (Child Psychiatry Division);
(c) the Harvard University Depart-
ment of Social Relations; and, (d) the
Graduate School of Education, seemed
to indicate that only a general sum-
mary would be informative and inter-
esting to the Trustees and others con-
cerned about the mental health of
children.

Therefore, although the intent to
give to the Trustees a definitive report
of the mental health activities in prog-
ress in the smaller unit (the Depart-
ment of Psychiatry of the Hospital)
is retained, we have attempted to pre-
sent an overview of integrated and
coordinated professional structures and
functions. Depending on the context,
we shall refer at times to (a) the
Hospital "Department of Psychiatry"
or (b) the "Judge Baker-Children's
Hospital" Division, the latter referring
in the main to our joint activities in
association with various Schools and
Departments of Harvard University.

DEPARTMENTAL STRUCTURE AND
BASIC SERVICE FUNCTIONS

The professional personnel of the De-
partment include three disciplines

traditionally involved in child psychia-
tric clinic treatment in America: child
psychiatrists, clinical psychologists,
and psychiatric social workers.

In this report-year (July 1959
through June I960), we have had a
total of fifteen staff psychiatrists work-
ing in the Department, but it is impor-
tant to note that not one of them is
full-time; seven are half-time ap-
pointees, and the remaining eight
work only four to sixteen hours per
week. The inability to appoint psy-
chiatrists to full-time status is, of
course, due to the fact that we lack
the financial resources.* These physi-
cians value highly their hospital and
clinic association because of the oppor-
tunities to teach and to do research,
but it is necessary for them to make
their livelihood in private practice.

There are eight clinical psycholo-
gists in the Psychiatry Department,
seven on full time. There also are
eight staff psychiatric social workers,
six on full time, one is on half time,
and one on quarter time.

The basic structure for the pro-
fessional functions of the Department
consists of the Central Psychiatry
Clinic, assigned personnel to the Medi-
cal Out-Patient and specialty clinics,
assigned personnel on call in the vari-
ous in-patient wards of the Hospital,
personnel assigned to the Good
Samaritan, the Children's Mission, the
Children's Cancer Research Founda-
tion, the Center for Blind Babies, the
Well Child and Family Care Programs
of the Department of Medicine, and
the Adolescent Unit.

The Central Psychiatry unit of
the Department is housed on the third
floor of Building A, and the renovated

* The expenditures for salaries of Psychia-
trists and for those in the other disciplines
within the Department, together with a state-
ment of the source of these monies, are given
in Appendix B of this report.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

building at 328 Longwood Avenue. It
has two important functions. In the
first place, it has for its personnel
people highly trained in child psychia-
try, psychiatric social work, and clini-
cal psychology who can carry out in-
tensive long-term treatment of chil-
dren referred from the various clinics
and wards through the Hospital. It
also is the nucleus of the whole De-
partment in that various psychiatric
"teams" are assigned from it to work
within the other clinics throughout the
Hospital. A notable example is the
assignment of psychiatrists, social
workers, and clinical psychologists to
the Adolescent Unit. These teams
carry out treatment within these clin-
ics and aid in the training and teaching
of personnel.

From the Central Clinic research
teams are organized to carry out re-
search projects in the Department or
in conjunction with personnel in other
Departments of the HospitaL

In short, the Central Clinic is the
Department of Psychiatry's main base
of operation, and its personnel have
overall supervision of its own treat-
ment, training and research functions
and such functions carried out by as-
signment to other services.

The personnel assigned to the
Medical Out-Patient Division of the
Hospital are housed on the second
floor of Building A, across the stair-
well from the Medical Out-Patient De-
partment, a convenient situation in the
joint activities of the psychiatrists and
psychologists with the pediatrician,
pediatric residents, and medical stu-
dents.

To each of the in-patient wards
and to the seven other areas listed
above are assigned psychiatrists and
psychologists who take part in psy-
chiatric consultations and psychologi-
cal evaluations of patients at the re-
quest of the staff or resident physicians

in these several areas. The personnel
of some of these medical and surgical
areas call upon us frequently for serv-
ices, some infrequently and some not
at all. Nonetheless, psychiatric teams
are assigned specific areas of coverage
throughout the Children's Hospital
Medical Center and respond to all re-
quests received.

A statistical summary of the
hours and sessions spent and the in-
dividual patients seen in (a) intensive
psychiatric treatment; (b) diagnostic
and (c) consultation services for
1959-60 appears in the table below.

In reviewing these figures it is
well to bear in mind that much more
clinic time of various personnel is re-
quired in mental health appraisals or
diagnoses (and certainly in psychiatric
treatment! ) than usually is the case in
other medical or surgical specialties.
In the mental health field both the

child and the mother (plus usually the
father in more recent years) must be
seen separately, in interview sessions
lasting one hour. Even a diagnostic
work-up takes a good many more
hours than one per patient. All these
needed hours and careful evaluation
cost society (and hospitals) a great
deal of money, but in the light of our
present body of knowledge and our
present accepted clinical procedures,
mental health work with children must
be carried out this way, and particu-
larly so in a hospital that is world
renowned for its diagnostic, treatment,
training and research facilities.

Education, training, and research

The education, training, and research
functions of the Department must be
viewed in the light of the integrated
efforts of the Hospital Department of
Psychiatry and the Judge Baker Guid-

SERVICE STATISTICS

July 1, 1959 -June 30, I960

Therapy sessions with patients 3,814
Interviews with parents of

patients 3,332

PSYCHOLOGICAL EVALUATIONS:
(separate visits by patients, not hours)
MOPD

patients 61 6

Wards

patients 278

Adolescent Unit

patients 200

House of Good Samaritan

patients 3

Seizure Unit

patients 2

Out-Patients (on a private fee level)

patients 109

Psychiatry Clinic

patients 37

Private In-Patients

patients 48

DIAGNOSTIC CONSULTATIONS:

MOPD

patients 585

parents 563

Adolescent Unit

patients 34

parents 1 5

Seizure Unit

patients 20

parents 15

Ward

patients 131

House of Good Samaritan

patients 9

Endocrine

patients 25

Total patients referred to the
Psychiatry Department for
evaluations 1,917

Average number of children seen
in therapy during current year 202

Average case load in intensive

treatment at any one time 140

DEPARTMENT OF PSYCHIATRY

ance Center. In their integrated seg-
ments they, in turn, relate to the ac-
tivities of the Department of Psychia-
try of the Harvard Medical School
since in combination the two units are
now considered a Division of this
medical school faculty group.

The Judge Baker Guidance Cen-
ter is the second oldest child psychiatry
clinic in America and, due to the sci-
entific work and writings of its first
Director, Dr. William Healy, has at-
tained a gratifying national and inter-
national reputation during its nearly
half century of work. However, the
Center, like most traditional child
guidance units, was established and
had developed somewhat outside the
main stream of medicine (and, in-
deed, of general adult psychiatry) . A
decade or more ago it became apparent
to leaders in the field of child psychia-

try that this separation from medicine,
particularly from pediatrics, was not
promoting mental health of children
either through psychiatry or through
pediatric care. The trustees and the
staff of the Judge Baker were among
the first to recognize the need for a
rapprochement between these two
fields and, as a practical matter, the
need for joint, or adjacent, facilities to
make coordination of the medical and
non-medical disciplines effective.

The Judge Baker had a decade
ago — and still has — 120 staff, resident-
in-training and graduate student per-
sonnel, four or five times more than in
the Hospital Department of Psychia-
try. It is of importance to note that
the Judge Baker has an invested en-
dowment of approximately $4,000,000,
whereas the hospital department has
none definitely earmarked for use in

FINANCIAL SHEET OF EXPENDITURES AND INCOME FOR PERSONNEL ONLY

July 1, 1959 - June 30, I960

Expenditures

Psychiatrists

Psychologists

Psychiatric Social Workers

Secretaries

$55,152.00

52,892.00

32,278.00

17,612.00

$157,934.00

This report is restricted to Personnel
only.

In addition to these grants for
staff personnel, the Department re-
ceived 24,000 to train Residents in
Psychiatry and Clinical Psychology, all
of whom contribute service to the hos-
pital and its various clinics. Also not
included in the above income are fees
from clinic patients or patients from
any of the outside units served by the
Department. Important also is the fact

Income from outside sources

(USPHS; Commonwealth Fund;

Hood Foundation; other)

$38,672.00

18,660.00

11,483.00

4,610.00

$73,425.00

that these figures do not reflect other
income received by the hospital
through this Department; viz, Over-
head, Social Security, and Retirement.
It is of importance to note that
the personnel costs to the Hospital
are not primarily in the medical dis-
cipline of psychiatry but rather in the
allied non-medical discipline of the
"psychiatric team," namely, Psychol-
ogy and Psychiatric Social Work.

psychiatry. Nonetheless, in spite of
these marked differences in numbers
of personnel and resources, it was felt
that if the Judge Baker were to carry
out correctly its existent and future
programs in the interest of child men-
tal health, the unit needed the obvious
values accruing in a meaningful affilia-
tion with the Children's Medical
Center.

In the fall of 1953 the Judge
Baker Child Guidance Center became
an affiliate of the Children's Medical
Center, and coordination of the ac-
tivities of the Judge Baker and the
newly established Hospital Depart-
ment of Psychiatry was begun. This
coordination is still in progress. In
1957 the Judge Baker occupied its
new building on Longwood Avenue,
directly opposite The Children's Hos-
pital. This new building contains fa-
cilities for the traditional out-patient
child guidance work of the Judge
Baker, plus facilities for two units for
additional and new functions.

First in importance was an in-
patient service, a unit that opened in
September of 1958. This unit is a
twenty-six bed in-patient service
which gives psychiatric care and edu-
cation to children who need to be
treated away from their own homes.

During 1959-60 there was an
average of seventeen in-patient chil-
dren on these two wards, and at the
time of this report there are twenty-
two. Needless to say, this in-patient
psychiatric section has added new op-
portunities for research and training,
and the staff and students of the hos-
pital unit participate in its operation
or receive training there.

The second new division, the
Manville School, took its first patient
in October 1957, and in the year
1959-60 had thirteen pupils. This
unit, which is essentially a psychiatric
day care program, has proved its worth

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

as a treatment and training center.

The professional staff functions
of both the Judge Baker and the Chil-
dren's Hospital Department follow in
most essential details the team work
structure of the traditional child psy-
chiatry clinic. The psychiatric team is
usually composed of a psychiatrist,
psychiatric social worker, and a clini-
cal psychologist. In most instances the
psychiatrist treats the child while the
mother meets with a trained social
worker. The traditional function of
the clinical psychologist was diagnosis
and research, but in recent years these
roles have been expanded. The clini-
cal psychologist now does counseling
under psychiatric supervision in these
medical settings. In the Judge Baker-
Children's Hospital Division of the
Medical School Department of Psy-
chiatry, there are at present approxi-
mately 150 professionally trained peo-
ple, most of whom are allied with one
of the three professions mentioned
above. However, in the last three years
there have been added to these cate-
gories people trained in (and for edu-
cation in) education, sociology, and in
anthropology.

In commenting upon the func-
tions of this Division of Child Psy-
chiatry in respect to education, train-
ing and research I will emphasize the
coordinated relationships which we
have established with

1. The Harvard Medical School

2. The Harvard Department of
Social Relations at the gradu-
ate level

3. The Harvard Graduate School
of Education

4. The undergraduate instruction
in Harvard College and Rad-
cliffe College

5. The Harvard School of Public
Health.

I also will emphasize the present
and future relationships of this Divi-

sion with the following Medical
School departments:

1. The Department of General
and Adult Psychiatry

2. The Department of Pediatrics

3. The Division of Child Neu-
rology.

CHILD MENTAL HEALTH
EDUCATION FUNCTIONS

Medical School Education

First Year. The members of this Divi-
sion at the Judge Baker and The Chil-
dren's Hospital offer lectures and
clinics in that segment of the new
curriculum entitled Growth and De-
velopment. These lectures, with illus-
trative clinical material, stress normal
personality growth in children. The
various tasks in personality develop-
ment set for the child are outlined,
together with the crises and threats
that may block or divert the normal
process of maturing.

Second Year. In association with
the Department of Pediatrics, lectures
are given to the second year medical
students which include the differential
diagnosis of various types and grades
of mental retardation, childhood
schizophrenia, and emotionally deter-
mined learning blocks.

Third Year. To the third year
medical students, six lectures are given
on the most frequently encountered
childhood neuroses and psychoses.

Fourth Year. In association with
the Department of Pediatrics of The
Children's Hospital, there are
( 1 ) weekly clinical exercises on the
responses of children to the effects of
hospitalization, and (2) a two-hour
session held with the fourth-year stu-
dents at the Massachusetts Mental
Health Center, dealing with the prob-
lems of adolescents.

In addition, the members of the
Psychiatry Department take part in
the clinical education of the Harvard
Medical School students: There are

weekly two-hour teaching conferences
at the hospital and at the Judge Baker.
In association with the Division of
Pediatrics at the Hospital, the depart-
ment supervises psychiatric teaching
of fourth-year medical students in the
Well Child Clinic and Family Health
Care program; this program is in the
Family Health Services. There is a
month's elective course in child psy-
chiatry offered at the hospital to the
fourth-year medical students. In this
course the students interview both
child patients and their parents and
take part in the psychiatric consulta-
tions of staff members with patients
on the wards. They also attend teach-
ing conferences and the research con-
ferences at The Children's Hospital
and at the Judge Baker across the
street.

Department of Social Relations
(Graduate Level)

Since the establishment of the Depart-
ment of Social Relations in the Uni-
versity in 1946, the Judge Baker has
been used as a field training unit for
the clinical psychologists following the
curriculum in that department. These
teaching functions have been carried
out at The Children's Hospital as well.
In the past academic year six students
at the second year graduate level have
been assigned to the Judge Baker-
Children's Hospital Division for an
internship in clinical psychology
throughout the academic year.

There are two-hour graduate
seminars (Social Relations 296A and
296B given at the Judge Baker each
week throughout both the Fall and
Spring terms). The second-year grad-
uate students in the Division of Clini-
cal Psychology of the Department of
Social Relations are required to take
this seminar. These seminars include
the orientation of the student in clinic
practices and offer instruction in the

DEPARTMENT OF PSYCHIATRY

diagnosis and counseling of child
patients and their parents.

Harvard Graduate School of
Education

Beginning with the fall term 1957,
Dr. Samuel Waldfogel, formerly the
Director of Research at the Judge
Baker, was appointed a Lecturer on
the faculty of the School of Education.
At the present time, he spends one half
of his time in course work on the
other side of the Charles River and
one half of his time with us at the
Judge Baker and the Hospital, as the
supervisor of graduate students from
that school.

Dr. Waldfogel and Professor Tiede-
mann of the School of Education be-
gan their first clinical course for the
training of educational psychologists
in clinical practices in the Fall of
1957. They set up field training units
both at the Judge Baker and in the
Newton School Counseling Unit, the
latter under the direction of Dr.
Edward Landy.

During the past year, two of the
students of the School of Education
received Tinkham Fellowships from
the Judge Baker, and two students of
the School of Education received Man-
ville Fellowships from the foundation's
grant given to the School of Educa-
tion.

In the Spring term eight students
from the Graduate School of Educa-
tion were admitted to Dr. Gardner's
middle Group Course, Social Relations
187 (The Emotional Problems of
Childhood and Adolescents).

For the next academic year
( 1960-61 ) Dr. Edleff Schwaab of our
staff will also hold an appointment as
a Lecturer in the School of Education.
Instruction of Undergraduates in
Harvard College and RadclifFe
College
Two courses to which undergrad-

uates are admitted are given in the
Department of Social Relations: Social
Relations 187 in the Spring term,
taken by approximately fifty under-
graduates, and during the Fall term,
Social Relations 131, dealing with the
"Social and Psychological Aspects of
the Practices of Medicine" and given
by Dr. Gardner and Dr. Croog, an
anthropologist who holds a joint ap-
pointment in the Department of Social
Relations and at the Hospital. This
course is offered to pre-medical stu-
dents and to seniors concentrating in
Social Relations. During the fall term
there were fifty to sixty students tak-
ing this course. Other members of the
Hospital staff, besides those in the
Psychiatry Department, assist in offer-
ing this sequence of lectures on med-
ical care and the meaning of disease to
the patient.

GRADUATE TRAINING PROGRAM

I would like to turn now to post-
doctoral residency training in child
psychiatry as carried out by the Judge
Baker-Children's Hospital Division in
Child Psychiatry. The entire child psy-
chiatry division of the Department of
Psychiatry at the Medical School com-
prises the largest residency training
program in child psychiatry in the
country. Training in this area began
at the Judge Baker in the 1930's, and
it has been due largely to affiliation
with the Medical School that the divi-
sion has grown to its present size. With
Dr. George Berry's help and guidance,
we now have seven fully approved
and fully accredited training clinics in
child psychiatry, including The Chil-
dren's Hospital and the Judge Baker.
All these clinics have residency train-
ing. Some of them train medical stu-
dents and non-medical pre- and post-
doctoral fellows: and all are engaged
in research in child psychiatry.

In the Judge Baker-Children's Hos-

pital coordinated training program in
child psychiatry, we have had fourteen
full-time residents in training during
the academic year 1959-1960. These
men and women work on both sides
of Longwood Avenue and study a
variety of childhood emotional dis-
orders with close supervision of the
psychotherapy. In addition, they fol-
low the course of didactic exercises
which have been set up for the Har-
vard Training Program in Child Psy-
chiatry and which all residents of the
clinics in the Harvard orbit are re-
quired to attend.

In addition to the residents men-
tioned above, we have residents from
the programs of training in general
psychiatry at the Massachusetts Mental
Health Center and the Boston State
Hospital; they come to the division for
orientation in child psychiatry but do
not intend to become specialists in this
field.

Lectures also are given to pe-
diatric residents at The Children's Hos-
pital. There is on-the-job training of
pediatric residents in the various out-
patient clinic areas in the hospital.

On Friday mornings throughout
the year, the residents on the Medical
Out-Patient Department present cases
for discussion to the Psychiatrist-in-
Chief.

The Department of Psychiatry
furnishes the Child Health Program
with four hours of consultation per
week and these consultation hours also
are devoted in large part to the in-
struction of both pediatric residents
and medical students. Two hours are
spent interviewing mothers before a
one-way mirror as a teaching device
for the demonstration of interview
technique. Two hours are devoted to
participation in teaching discussions
with the staff of the program and the
third year Harvard Medical Students.
The psychiatric implications of child

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

rearing practices, the dynamics of fam-
ily interactions, and normal growth
and development are discussed.

In addition, we furnish periodic
consultations on specific cases for
which the staff requests assistance. We
participate in the occasional policy
meetings on the teaching aspects of
the program.

Finally, weekly instruction is of-
fered by members of the Department
through the psychiatrist assigned to
the Family Health Care Program of
the Hospital.

The most important part of the
work is not to teach psychodynamics
or the theory of psychopathology, but
to contribute from psychiatric experi-
ence and personality theory pertinent
information for understanding "nor-
mal" family interactions, the psycho-
logical reactions to medical illness, the
significance of the doctor-patient rela-
tionship, and the psycho-social aspects
of medical practice. These items have
been dealt with as they came up in the
course of case discussions or when a
student requested a consultation about
a particular family. The general prob-
lems that students might encounter in
their roles as new doctors have been
discussed without mixing into their
private affairs gratuitously.

An additional function is to dis-
cuss with the physicians and students
the genesis and management of psy-
chiatric disorders in their patients as
these arise in the course of the year.
Whenever possible, direct diagnostic
or therapeutic contact with the patients
has been avoided, the students and
trainees manage the necessary suppor-
tive therapy when feasible and other-
wise supervise the referrals for defini-
tive psychiatric treatment with the help
of the Social Worker, Mrs. Brenner.

It is important to add that selected
staff members and students from the

Children's Mission to Children are
present at these exercises.

Training in the Social Sciences

During the past year we have had four
post-doctoral students in training in
clinical psychology in the Judge Baker-
Children's Hospital unit.

Five years ago the Judge Baker
received a training grant from the
United States Public Health Service to
establish a model training program for
personnel to work in the field of juve-
nile delinquency. This grant was for
$100,000 per year for five years and it
is in its write-up stage. The various
installations organized for the training
of students (both physicians and non-
medical personnel) are the Judge
Baker Guidance Center, units at the
Boston Juvenile Court and the Cam-
bridge Court, and the Newton School
Counseling Center. This course in
1959-60 included clinical training in
these various installations plus lectures
and seminars. Enrolled at the moment
are child psychiatrists, students from
the Harvard Graduate School of Edu-
cation, students from the Department
of Social Relations, men from the
Divinity School, and students from the
law school.

During the academic year, 1957-
58, the Medical School, in conjunction
with the School of Public Health, and
the Department of Social Relations,
established a training program for
social scientists in the medical field.
These three divisions of the Univer-
sity organized this program with the
help of a five-year grant from the
United States Pubic Health Service.
The Division of Child Psychiatry, like
the various divisions of the department
of general psychiatry, takes part in the
instruction of these men and women
who wish to apply social science meth-
ods to the study of problems of health.

RESEARCH

In the year 1959-60, the Judge Baker
and Children's Hospital psychiatric and
social science personnel took part in
a coordinated program of research on
the following aspects of normal and
abnormal child development: Anorexia
nervosa, school phobias, seizures, juve-
nile delinquency, childhood schizo-
phrenia, the effects of congenital de-
fects upon personality development,
impairment of the learning process in
normal children, basic studies in pat-
terns of child personality development.

Much of this research concerns
the problem of aggression and counter-
aggression in children. We hope to
throw light on the expression of this
instinct and control of it. These pro-
grams are carried out under grants
from the United States Public Health
Service, the Hood Foundation, and
from the Scottish Rite Foundation for
Research in Dementia Praecox.

Dr. Peter Wolff, a United States
Public Health Service Career Investi-
gator, is carrying out research studies
on babies in the first twenty-four hours
of life.

Dr. Sidney Croog, an anthropol-
ogist, is concluding a study of The
Children's Hospital and its allied units
as a community child health center.
Dr. Croog is a Research Fellow of the
Russell Sage Foundation.

Dr. Eric Lennenberg, a United
States Public Health Service Career In-
vestigator, in 1959 began his work on
speech development and speech path-
ology, his aim being to study the devel-
opment of speech and language from
physiological, neurological, and psy-
chological viewpoints. This research
may lead to new diagnostic tools in the
examination of children with abnormal
speech behavior; may give new in-
sights for the management of speech
and language disability, and, most im-
portant of all, may provide new data

DEPARTMENT OF PSYCHIATRY

concerning the biological prerequisites
of speech development in the human
infant. Dr. Lennenberg's research
grant is for five years.

Dr. Geraldine Rickard and Dr.
Haskel Cohen, through Funds from
the Hood Foundation and the Wolbach
Fund, are developing a psychological
test to determine children's progress
in emotional development. The aim is
to perceive basic patterns in relation to
the selected tasks of emotional devel-
opment. With such information on
norms psychiatric personnel would be
better equipped to determine the areas
in which emotional problems exist.

FUTURE NEEDS AND
ITEMS FOR DISCUSSION

In the foregoing survey I have out-
lined the treatment, training and re-
search activities and programs of the
Department of Psychiatry of The Chil-
dren's Hospital Medical Center in the
year July 1959 to July I960. I have
stressed those activities and work of
the Department's personnel in the hos-
pital proper and have included the co-
ordinated work with the affiliated
Judge Baker Guidance Center. In con-
clusion, I would like to list needed new
programs or needed expansion of ex-
isting programs that would add to our
effectiveness in dealing with the men-
tal health problems and behavioral de-
viation of children. I say "list" ad-
visedly because almost all of these items*
require the careful consideration of
the Board ( or Boards ) of Trustees and
the Chiefs of various services of the
Hospital (and the Judge Baker) be-
fore definite detailed outlines and pro-
posals are blueprinted — and surely
before cost and space requirements are
defined.

It is well to bear in mind, too, that
in the past psychiatric programs to be
carried out for either children or adults

in a general hospital have had to
evolve slowly and the need for them
has had to be pressing to — and to be
pressed by — the personnel in depart-
ments other than Psychiatry itself. For
example, although all medical person-
nel may readily see the need for a new
ophthalmological or nutrition division,
or for an extension of a post-natal care
program, the needs for this or that new
program in the new field of child
mental health are not so easily demon-
strated or accepted. Child psychiatric
care and prevention programs are
usually expensive affairs. These re-
peatedly demonstrated facts should be
known and appreciated by trustees — ■
and most important of all, they should
be known, appreciated, and understood
by the psychiatrist who may be urging
new or expanded programs.

With these reservations in mind,
I suggest a consideration of the follow-
ing items (listed not necessarily in the
order of their importance) in respect
to future programs relevant to the
mental health care of children at The
Children's Hospital Medical Center:

1. There is the need for a modest
number of beds in The Children's Hos-
pital with proper facilities for the care
of child psychiatric emergency cases
that are from time to time brought to
our out-patient or emergency clinics,
or that develop in the hospital on one
or another medical or surgical services.
Although we have twenty-six beds on
the in-patient service at the Judge
Baker, we are not equipped either by
ward structure or personnel to handle
the youngster who presents an acute
behavioral emergency.

2. We definitely need expansion
of the psychiatric treatment and re-
search facilities to include the infant
and pre-school child, psychological
testing programs, and, especially, pro-
grams of training for clinical psychol-

ogists who may, we hope, become spe-
cialists with this particular age group.

3. There is a need to include men-
tal health principles and mental health
personnel in the recreational and edu-
cational programs for in-bed and con-
valescent patients. I am referring here
specifically to the already nationally
recognized programs that are being
carried out at the Floating Hospital
under Dr. Tisza, and at the Boston
City Hospital under Dr. Gellis.

4. With the contemplated estab-
lishment of a new Department of
Neurology it is hoped that cooperative
schemes of training, treatment, and
research will go forward. It seems to
me that with an expanded and defini-
tive Department the widest spectrum
of cases of both the organic neurolog-
ical and the emotional-behavioral type
could be cared for within our own
Children's Hospital Medical Center.
It presents an opportunity for a broad
and eclectic treatment program, and
for a training and research approach
to these disabilities of childhood.

5. The possibilities for the ap-
pointment of one or two full-time psy-
chiatrists to our staff should be ex-
plored seriously. In the Department
of Psychiatry — as in some of the other
departments of the Hospital — the lack
of outstanding "personnel in depth"
constitutes, to my mind, a serious situ-
ation, in the evolvement of future
treatment and research programs and
in the maintenance of a Harvard teach-
ing program of high quality.

6. I have already presented to
the Chiefs of Staff and to the Director
of Development of the Hospital the
hope that monies may be found for
the establishment by Harvard Medical
School of a professional chair in child
psychiatry at The Children's Hospital.
It seems to me that The Children's

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Hospital is the logical and sensible
place for such a chair.

7. To turn to present-day needs
for a moment, I recall writing to the
administration in 1954 a detailed out-
line of the pressing need in the de-
partment for (a) added support for
the treatment facilities in the Central
Psychiatry clinic and (b) a more real-
istic view of the psychiatrist-psychiatric
social worker ratio in that clinic. Both
of these needs are pressing and our
work could be greatly enhanced by
meeting them if this is at all possible
at the present time.

8. It is our hope that through the
help of Dr. Janeway we will be able
to find stipends for a year's training in
child psychiatry for those appreciably
large numbers of board-eligible pedia-
tricians (25 or more per year) who
apply to the Department for such
training. Thus far we have not been
able to secure these stipends, though
both Dr. Janeway and I have tried
various possible sources over the past
two years.

9. Finally, looking as objectively
as possible at the present relationships
between the Judge Baker department
and The Children's Hospital Medical
Center department of psychiatry, I
think beginning discussions relative to
the future administrative unification
of these separate departments would
be profitable. Such discussions, of
course, should involve the Chiefs of
Staff of the Hospital, Dean Berry of
the Medical School, the Trustees of
the Children's Hospital Medical Cen-
ter, the Trustees of the Judge Baker
Guidance Center, and the staffs of both
the Judge Baker and the Hospital De-
partment. Under the affiliation status
the two departments, it is true, have
developed over the past six years many
coordinated and cooperative programs

as outlined above, and this cooperation
will probably go on apace in the years
immediately ahead. However, it is my
feeling that preliminary exploratory
discussion relative to the possible inte-
grations of these two departments
should begin.

George E. Gardner, Ph.D., M.D.
Psychiatrist-in-Chiej

Bibliography

Blitzer, J. R., Children who starve them-
selves. Anorexia-nervosa. J. Psycho-
som. Med. (In press.)

Caudill, W., Observations on the cul-
tural context of Japanese psychiatry.
In Opler, M. (Ed.), Culture and
Mental Health, Macmillan, 1959.

, Relationship of anthropology

to psychiatry in the study of culture
and personality. Jap. J. Psychoanal.,
1959.

, Similarities and differences in

psychiatric illness and its treatment
in the United States and Japan.
Mental Hygiene, Seishin Eisei, 1959.

Fineman, A. D., Preliminary observa-
tions on ego development in children
with congenital defects of genitouri-
nary system. Am. J. Orthopsychiat.,
29(1): 110, 1959.

Gardner, G. E., Adjustment difficulties
during adolescence. In Stuart, H. G,
and Prugh, D. G. (Eds.), The
Healthy Child: His Physical, Psycho-
logical and Social Development.
Harvard, I960.

, Discussion of: Rosenbaum,

M., Role of psychological factors in
delayed growth in adolescence. A
case report. Am. J. Orthopsychiat.,
29:769, 1959.

-, Juvenile delinquency as a

development task failure. U. S.
Public Health Service Publications,
1959.

-, Mental retardation as part

of the training program in child
psychiatry. In Bowman, P. W., and
Mautner, H. V. (Eds.), Mental Re-
tardation: Proceedings of the First
International Medical Conference.
Grune & Stratton, I960.
, Observational research with

emotionally disturbed children: Ses-
sion II. Symposium, 1958. Discus-
sion. Am. J. Orthopsychiat., 29:590,
1959.
, Psychiatric problems of ado-

DEPARTMENT OF PSYCHIATRY

lescence. In Arieti, S. (Hd.) , Ameri-
can Handbook of Psychiatry, Vol I.
Basic Books, 1959.

-, The public's right to know.

Symposium. /. Nat. Prob. & Parole
Assoc, 5:431, 1959.

Kaufman, I., Frank, T., Heims, L.,
Herrick, J., and Wilier, L., Four
types of defense in mothers and
fathers of schizophrenic children.
Am. J. Orthopsychiat., 29:460, 1959.

Lenneberg, E. H., Language, evolution,
and purposive behavior. In Culture
in History: Essays in Honor of Paul
Rodin. Columbia, I960.

, Review of Penfield, W., and

Roberts, L., Speech and Brain
Mechanisms. Language: 36, No. 1,
I960.

Makkay, E. S., Adolescent girls. In
Stuart, H. E., and Prugh, D. G.
(Eds.), The Healthy Child: His
Physical, Psychological and Social
Development. Harvard, I960.

, Meaning and use of relation-
ship in freeing adaptive functions of
the ego. Case Studies Smith Coll.
Sch. Soc. Wk. (In press.)

-, Some problems in the differ-

ential diagnosis of pre-delinquency
in early latency. /. Am. Acad. Child.
Psychiat. (In press.)

-, Kaufman, I., and Zilbach, J. J.,

Impact of adolescence on girls with
delinquent character formation. Am.
J. Orthopsychiat., 29:130, 1959.

Waldfogel, S., Emotional crisis in a
child. In Burton, A. (Ed.), Case
Studies in Counseling and Psycho-
therapy. Prentice-Hall, 1959.

, Tessman, E., and Hahn, P. B.,

A program for early intervention in
school phobia. Am. J. Orthopsychiat.,
29:324, 1959.

Wolff, P. H, Developmental psycholo-
gies of Jean Piaget and psycho-
analysis. In Psychological Issues,
Vol. II, No. 1, Mono. 5. Interna-
tional Universities Press, I960.

, Discussion of: Chambers, J.,

Maternal deprivation and the con-
cept of time in children. Am. J.
Orthopsychiat., 31:416, 1961.
, Observations on newborn in-
fants. Psychosom. Med., 21:110,
1959.

DEPARTMENT OF RADIOLOGY

REPORT OF
RADIOLOGIST-IN-CHIEF

When the annual statistics of the De-
partment of Radiology are compared,
it is evident that the increase in the
work load of the Department is to
some extent predictable. An increase
approaching 10 per cent annually is to
be anticipated. There has been but
one exception, the year 1957. In that
year there was a great deal of pub-
licity about the hazards of radiation.
Through methods of mass commu-
nication facts already known to ra-
diologists were made public, some-
times in a distorted and exaggerated
form. The reaction of fear and worry
may well account for the diminution
in the rate of increment during that
year. In spite of an increase in the
work load and the complexity of the
examination, our records indicate that
the number of films used per examina-
tion has presumably leveled off to the
reasonable figure of approximately two
and three-quarters films per examina-
tion.

It is also possible to predict in
a rough way the accretion in staff
needed to carry out satisfactorily the
increasing load placed upon the De-
partment. The studies that have been
made suggest that one radiologist
should attempt to handle no more
than 10,000 cases per annum, and
it is probable that in a teaching hos-
pital this figure should be consider-
ably lower. An increase of 2000 com-
plicated examinations warrants one
more technician and this, of course,
necessitates the addition of other key
personnel to maintain the smooth
functioning of the Department.

During the past few years radi-
ography as a science has entered an
almost revolutionary era. With rapid
advances in electronic techniques,
new methods of radiological explora-
tion are now available that are safer
for the patient and diagnostically
more rewarding. Image amplifiers,

television techniques and moving pic-
tures or cinefluorography are now
routine procedures in the Department.
The Hospital must anticipate in the
future considerable capital expendi-
ture so that the very latest advances
in these new techniques may be ap-
plied to the care of children, to re-
search and to teaching. To cite but
a single example, the present image
amplifiers give over a 3000-fold light
gain, enabling the radiologist to re-
duce the amount of x-radiation to the
patient to almost one-fortieth of that
given before. At the same time the
image is vastly improved so that
lesions barely detectable by the older
modalities now become clearly evi-
dent, and can be demonstrated on tele-
vision and recorded on movie film.
The Hospital must not lag behind
either in the application of these few
facilities in the Department of Ra-
diology or in eagerly anticipating the
use of television for teaching, research
and patient care in other areas of the
Hospital.

The research activities of the De-
partment continue with a number of
fields of major interest. The division
of Radiotherapy under Dr. Giulio J.
DAngio has been investigating Ac-
tinomycin D in combination with
x-ray therapy, particularly in regard
to normal tissue effects, effect on ani-
mal tumor systems and comparison
with other chemotherapeutic agents.
At the same time search is being con-
tinued for other radiation sensitizers,
such as the nitrofurans. A third area
of research is the comparison of the
effects of the particulate radiation
(high speed electrons) and electro-
magnetic radiation (x-rays) on the
growing bones of rabbits. Other in-
vestigators are collaborating in these
studies. Included among them are Dr.
Charlotte L. Maddock of the Children's
Cancer Research Foundation and Mr.

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Kenneth Wright of Massachusetts In-
stitute of Technology.

The division of Radiotherapy
also provides the technical facilities
for other investigators pursuing many
differing experiments. Among those
using the facilities of the Department
are Drs. Alfred H. Handler and Rich-
ard Adams working on the irradiation
of tumor-bearing hamsters, these stud-
ies having to do with chemotherapeu-
tic agents and in the immune mecha-
nisms of tumor-host relationships. Dr.
John F. Enders and his associates are
utilizing x-ray therapy in their studies
employing tissue culture techniques
on leukemogenesis and virology. Dr.
Carl Partanen has used x-radiation in
conjunction with his studies on spon-
taneous tumors developing in the fern,

while Drs. Hans Meier and Maddock
have worked on bone marrow trans-
plantation in irradiated rats and Dr.
David Gitlin on adrenal function of
mice in relation to irradiation. These
studies and others utilizing x-radiation
equipment and the services of Dr.
D'Angio and his staff indicate that
his division has been very active in-
deed. Although there has been no
notable change during the past three
years in the number of patients
treated, approximately 3,600, the very
active research program has and will
contribute a great deal toward the
understanding of a number of im-
portant problems.

Mr. Eric Hammond, the Techni-
cal Assistant to the Department of
Radiology, has done significant re-

search in methodology and in the en-
gineering of new equipment. He has
worked closely with the Keleket Com-
pany in developing the now functional
forms of image amplification. In addi-
tion to his activities within the De-
partment, Mr. Hammond has been
helpful in planning and development
for the Departments of Cardiology,
Pulmonary Physiology and Dentistry.
The demand for his knowledge and
experience has become so great that
it is difficult to keep his activities
from becoming unproductively dif-
fuse.

The research activities of the
Diagnostic division have continued on
the physiology of pulmonary hyper-
tension, the development of the man-
dible in the fetus and newborn, the

SUMMARY FOR THE DEPARTMENT OF RADIOLOGY

Year Ending

September 30, 1959

Old cases

New cases

X-Ray

Month

Films

Diagnostic

Therapy

1959
Total Films

74,453

October

6,139

1,517

678

319

Total Diagnostic Cases

27,095

November

5,844

1,457

676

289

Total Treatments

3,546

December
January

5,752
6,585

1,409
1,594

681
798

307
330

1958

Total Films

Total Diagnostic Cases

70,693
25,337

February

5,744

1,365

642

281

Total Treatments

3,676

March

6,074

1,460

724

212

1957

April
May

6,392
6,285

1,499
1,492

804
782

246
346

Total Films

Total Diagnostic Cases

Total Treatments

71,511

25,123

3,405

June

6,457

1,585

787

400

1956

July

6,814

1,764

785

252

Total Films

Total Diagnostic Cases

65,317
23,000

August

6,185

1,526

741

305

Total Treatments

2,419

September

6,182

1,577

752

259

1955

8,850

3,546

Total Films

Total Diagnostic Cases

Total Treatments

58,532

Totals

74,453

18,245

20,233
2,191

DEPARTMENT OF RADIOLOGY

complications of cystic fibrosis of the
pancreas, and the utilization of aerosols
in double contrast study of the large
bowel. In addition, a number of small
clinical programs are being actively
pursued.

The members of the Department
have been particularly active in teach-
ing. Mr. Hammond has taught a num-
ber of classes at Northeastern Univer-
sity in the courses for X-ray techni-
cians. Two student technicians from
the Saint John General Hospital,
Saint John, New Brunswick, and one
from the Peter Bent Brigham Hospi-
tal rotate through the Department
every three months. During the year
twenty-six undergraduate or graduate
medical students have spent one
month or more in the Department,
and it is probable that no Department
in the Hospital conducts more con-
tinuous teaching; at least one mem-
ber of the Department is teaching
every hour during the day. In addi-
tion, the staff has been active on the
national scene; some twenty-eight out-
of-town lectures were given in the
course of seventeen out-of-town trips.
Committee appointments are held by
all members of the Department in na-
tional roentgen organizations.

After completing his three-year
term, Dr. Martin H. Wittenborg re-
signed as Consultant to the National
Institute of Health, where he served
on the Clinical Studies Panel and the
Experimental Design Committee of
the Cancer Cooperative Studies Pro-
gram; he has accepted appointment as
member of the National Research
Council Division of Medical Sciences
of the National Academy of Sciences
as representative of the American
Roentgen Ray Society. The Radiolo-
gist-in-Chief has served as President of
the American Roentgen Ray Society
and concurrently as the first President
of the newly formed Society of Pedia-

tric Radiology. It is of interest that
of the charter members of this society,
approximately two-thirds obtained
their Pediatric Radiology training at
The Children's Hospital of Boston.

Increasing demands have been
made upon the Children's Hospital
Committee on Radiation Safety as a
result of the increased activity within
the Hospital, involving almost all
services, of research using radioactive
isotopes. The Committee acts in an
advisory capacity as well as itself
maintaining safety standards to protect
patients and personnel against radia-
tion hazards. Of this hard-working
Committee of three, two are members
of the Department of Radiology, Dr.
D'Angio and Dr. Wittenborg, Chair-

man.

Drs. Eckart Sachsse, Urfan Jaw-
hari, John Tampas, Robert Berk and
Norman Sadowsky have served as
Residents, while Dr. Sisir Bose from
India served for over a year as a
Rockefeller Fellow, Dimitrije Radjic
as a Fellow from his own University
at Kingston, Ontario, Dr. Mustaga
Sipahi served as Rockefeller Fellow
from Ankara, Turkey, and Dr. Ithamar
Aviad as Hadassah Fellow from Is-
rael. Among the Volunteer Assistants,
there has been Dr. Vivian Harris
from New York, Dr. Nurettin Eryil-
maz from Turkey, Dr. Ernest Frinton
from Vancouver, B. C, and Dr. Keith
Rapp from Boston.

Life in the Department of Radi-
ology appears to be one of constantly
increasing activity. On the whole, the
affairs of the Department have run
smoothly and the credit for this goes
to the loyal and enthusiastic teamwork
of every one of the thirty-four mem-
bers of the Department.

E.B.D. Neuhauser, M.D.
Radiologist-in-Chief

Bibliography

D'Angio, G. J., and Brown, B., The
potentiation of x-ray effects on
normal mouse skin by actinomycin
D. Proc. Am. Assoc. Cancer Res.,
3:103, 1960.

D'Angio, G. J., Evans, A. E., and Mitus,
A., Roentgen therapy of certain com-
plications of acute leukemia in child-
hood. Am. J. Roent., Rod. Therapy
& Nuclear Med., 82:541, 1959.

D'Angio, G. J., Farber, S., and Mad-
dock, C. L., Potentiation of x-ray
effects by actinomycin D. Radiology,
73:175, 1959.

Maddock, C. L., Brown, B., and
D'Angio, G. J., Enhanced response
of Ridgway osteogenic sarcoma to
x-radiation combined with actino-
mycin D. Proc. Am. Assoc. Cancer
Res., 3:131, I960.

Neuhauser, E. B. D, Planning the pro-
gram. President's address to 60th
annual meeting of American
Roentgen Ray Society. Am. J.
Roent., Rod. Therapy & Nuclear
Med., 82:755, 1959.

DIVISION OF LABORATORIES AND RESEARCH

DIVISION OF LABORATORIES
AND RESEARCH

The Division of Laboratories and Re-
search was established on July 1, 1946,
following a careful study of the needs
of The Children's Medical Center and
an evaluation of the opportunities of
the hospital and all cooperating units,
for the greatest contribution to Pedia-
trics.

The experience of the Depart-
ment of Pathology during the preced-
ing twenty years formed the basis of
this new conception, which was de-
scribed in terms of the utilization of
technics of Biology, Chemistry, and
Physics, applied to the several disci-
plines of Immunology, Experimental
Pathology, Pharmacology, Physiology,
Genetics, and the like, for the solution
of mental and physical problems con-
cerned with the normal and with the
sick infant, child, and adolescent. In
addition to the performance of its own
research, the Division of Laboratories
and Research was organized to pro-
vide expert professional assistance to
the research programs originated and
conducted by the several clinical de-
partments of the hospital.

The grouping together of all of the
clinical routine laboratories in one de-
partment of Clinical Laboratories has
provided a professional competence
and supervision of a caliber never be-
fore realized, and has added impor-
tantly to the hospital income.

Only one of the planned labora-
tories of research basic to Pediatrics
was founded directly within the hospi-
tal. This was the Laboratory of Infec-
tious Disease Research, under Dr.
John F. Enders.

Because of developments which
were both natural and fortunate, the
outgrowth of the cancer research pro-
gram in the Department of Pathology
resulted in the creation of The Chil-
dren's Cancer Research Foundation, in
1948. This organization, now affiliated
with The Children's Hospital Medical

Center, provides the facilities for the
Laboratories of Infectious Disease Re-
search, and also for the many labora-
tories — Chemistry, Biophysics,
Pharmacology, Experimental Biology
and Pathology, and Botany — in addi-
tion to an Outpatient Clinic which
cares for the largest number of chil-
dren with leukemia and other forms
of cancer in the world.

DEPARTMENT OF PATHOLOGY

This is the pioneer department of
Pediatric Pathology, first under the
late Dr. S. Burt Wolbach, who was as-
sociated with it in a part-time capac-
ity for almost forty years. The present
Pathologist-in-Chief, Dr. Sidney Far-
ber, has served the hospital continu-
ously since 1927, and holds the posi-
tion of Professor of Pathology,
Harvard Medical School, at The Chil-
dren's Hospital. Many of the impor-
tant laboratories of Pediatric Path-
ology in this country, Europe, and
Latin America which have been or-
ganized since World War II are
headed by men who have received all
or part of their training here. The
laboratory continues to give training
not only to pathologists, but also tc
clinicians as a background to their
future medical or surgical activities.

The routine of the Department
is the responsibility of Dr. Gordon F.
Vawter and his Junior and House
Staff. The work has been of high cali-
ber and has been rendered with devo-
tion and unselfishness not exceeded in
any Laboratory of Pathology. The
post-mortem examinations, which give
information of such great importance
to both doctors and the families of
patients, are performed with thor-
oughness of research endeavors, and
are recorded with care. Dr. Vawter
and his colleagues are always available
to members of the Clinical Staff and
render an enormous amount of assist-

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

ance in the solution of their problems.
Such help is difficult to identify and
frequently is not sufficiently recog-
nized. The willingness of a staff to
carry out such a function, in addition
to its own research activities, makes
the difference between a great and an
ordinary hospital. Dr. Vawter is main-
taining a tradition which has been in
operation without interruption for
several decades.

From July 1, 1959 to June 30,
I960, the department performed 366
autopsies, 113 guinea pig examina-
tions for tuberculosis, examined 656
bone marrow and 1517 other surgical
specimens, and held 381 consultations.
Members of the department in
training included:

John Craig Kosek

Resident
Ronald Garry Davidson

Assistant Resident
George Diamandopoulos

Asst. Resident (6 mos.-PBBH)
Raymond McBride

Asst. Resident (6 mos.-PBBH)
Herman Polet

Asst. Resident (6 mos.-PBBH)
Francis W. Sullivan

Intern
Donald Singer

Intern
Edward Gerber

Voluntary Assistant with
duties of Intern (5 mos.)

The department supplied two
one-day-per-week instructors for Har-
vard Medical School Pathology, and
an instructor for one unit in Patho-
physiology. A fourth-year medical
student from Duke University and a
second-year medical student from Jef-
ferson Medical College each spent two
months in the department. Additional
hours of formal teaching of Harvard
Medical students were irregularly
scheduled. Members of the depart-
ment provided instruction for The

Children's Hospital Medical Center
Nursing School, Harvard Postgraduate
Course in Cardiology, and the Boston
University fourth-year Pathology
course. The departmental conference
schedule has been continued, and
Clinical Pathological Conferences con-
tinue to be supplied to the Journal of
Pediatrics at the rate of one per
month.

The contributions of Dr. J. Le-
Roy Conel, continuous since 1931, are
recorded in volume after volume de-
scribing the development of the brain
at various age levels. Dr. Conel has
continued to work actively for many
years since his official retirement. His
contribution is recognized the world
over, and forms the basis for evalua-
tion of the development of the brain
and of behavior patterns in infants
and children.

It is sad to record the loss of Dr.
J. Lewis Bremer, at the age of eighty-
five. He continued to work produc-
tively almost to the end. His book on
the embryologic basis of congenital
malformations, published by the Har-
vard Press shortly before he died, rep-
resents a major contribution to Pedia-
trics, Embryology, and Surgery. Dr.
Bremer was an inspiration to the
young members of the Staff during
the eighteen years he worked in the
Department of Pathology after his of-
ficial retirement as Professor of Em-
bryology at Harvard Medical School.

The latest addition to the De-
partment of Pathology came three
years ago when we established the
Subdivision in Neuropathology, under
the leadership of Dr. Betty Q. Banker,
a doctor expertly trained as a neurolo-
gist as well as a neuropathologist.
This laboratory has grown even faster
than we had hoped. Dr. Banker's
valuable contributions to the profes-
sional staff and to the teaching of
medical students and house officers

have been documented in a series of
publications and hospital records. She
has provided the basis for many ac-
tivities in the Departments of Neu-
rology and Neurosurgery. Excerpts
from her annual report are included
as she has written them.

There follows selected portions of
the reports of the heads of several
subdivisions of the Division of Lab-
oratories and Research.

Neuropathology

Dr. Betty Q. Banker

The Neuropathology Laboratory is a
unit within the Department of Path-
ology. This laboratory was established
by Dr. Farber three years ago. The
group is comprised of several physi-
cians, laboratory technicians, and a
secretary. The functions of this group
are multiple:

1. The routine study of biopsy
and autopsy material of neuropatho-
logical interest.

2. The special study of problems
encountered in the course of the rou-
tine study.

3. The establishment of a teach-
ing center for many to learn the basic
fundamentals of neuropathology.

4. The presentation of neuro-
pathological material to the patholo-
gists neurologists, neurosurgeons, and
pediatricians.

Scope of Work. Data from approxi-
mately 80 per cent of the autopsies
have been studied in this laboratory.
Reports from each case are incor-
porated into the pathology protocol.
There is a wealth of opportunity for
study because many problems in pedi-
atric neurology are unexplored and un-
described. In many diseases, there has
been no attempt to study accurately,
nor to understand the pathogenesis.
This subject of Pediatric Neuropa-
thology is truly in its infancy.

DIVISION OF LABORATORIES AND RESEARCH

Personnel. The number of research
fellows varies over the course of each
year. Each year there has been a full-
time fellow. In addition, residents
from Neuropathology at the Massa-
chusetts General Hospital rotate every
three months for a two-month period
at Children's Medical Center and a
one-month period at the Warren
Museum.

Last year, one of our neuro-
surgeons spent six months in the lab-
oratory. Each year a travelling fellow
from a European country has also
joined our group.

STAFF

1. Betty Q. Banker, M.D.

2. James Q. Miller, M.D.

Fellow — National Institutes of
Health. July 1, 1960-July 1, 1961.

3. Olga M. Blair, M.D.

Fellow— December 1, 1958-July
1, 1960.

4. Frederick Horner, M.D.

Fellow — November 1, 1958-May
1, 1959.

5. Jeanne-Claudie Larroche, M.D.
Rockefeller Fellow — January,
1959-August I960.

6. James Robertson, M.D.

Fellow in Neurosurgery CHMC
—September, 1959-AprU, I960

7. Gerald Winkler, M.D.

Fellow in Neuropathology MGH
— September, 1959-December,
1959.

8. William J. McEllroy, MD.
Fellow in Neuropathology MGH
—January 1960-April I960.

9. Daniel B. Drachman, M.D.
Fellow in Neuropathology BCH
— February I960.

10. Chim Mayman, M.D.

Fellow in Neuropathology MGH
—May 1960-July I960.

11. Federiko Lopez, M.D.

Fellow in Neuropathology MGH
—June 1960-October I960.

12. Alexander McPhedran, M.D.
Fellow in Neuropathology MGH
July 1960-October I960.

Conferences. There is a great demand
for teaching conferences by the neurol-
ogists, neurosurgeons, and other
groups in the city. Although these
meetings serve as a stimulus, too much
time in the course of one day is spent
in conferences. At the present time,
for the size of the senior staff, a typi-
cal week is shown below.

CONFERENCES IN NEUROPATHOLOGY

Purpose

Day

Time

Place

Group

Monday
Tuesday
Thursday

9-12

Neuro-
pathology

Routine
Microscopic

Neuropathology

Wednesday

9:30-10:30

Pathology
Library

Neuropathology
Presentations

Neurology and
Pathology

Friday

9-11

Autopsy
Room

Weekly Gross
Neuropathology

Pathology and
Neuropathology

Friday
q 2 weeks

4-6

Autopsy
Room

Clinical

Neuropathology

Conference

CH.M.C. and

Boston City

Hospital

Saturday
q 2 weeks

9-10

Pathology
Library

Microscopic of
Brain tumors

Neurosurgery and
Neuropathology

Presentations in 1939-1960

1. Banker, Betty Q.

Occlusive Cerebral Vascular Dis-
ease in Infancy and Childhood.
American Neurological Associa-
tion, Atlantic City, June 1959.

2. Craig, John M. and Banker, Betty Q.
Atypical Form of Gargoylism.

American Pediatric Society, Buck
Hill Falls, May 1959.

3. Byers, Randolph K. and
Banker Betty Q.

Muscle Disease in Infancy and
Childhood (A Ten-year study).

International Pediatric Congress,

Montreal, July 1959.

4. Robertson, James and
Banker, Betty Q.

Spongy Degeneration in Infancy
and Childhood (A Clinical Patho-
logical Study).

American Academy of Neurol-
ogy, April I960.

5. Banker, Betty Q. and Larroche, J. C.
Non-Progressive Periventricular
Leukomalacia.

American Association Neuro-
pathologists, Boston, June I960.

6. Byers, Randolph K. and
Banker, Betty Q.
Werdnig-Hoffmann's Disease.

American Neurological Associa-
tion, Boston, June I960.

7. Banker, Betty Q.

The Experimental Studies in Peri-
ventricular Leukomalacia.
American Academy of Neuro-
surgery, Boston, October I960.
Projects. The following work is in
progress and should be in press within
the next few months:

1. Spongy Degeneration of In-
fancy

2. Arthrogryposis Multiplex Con-
genita

3. Periventricular Leukomalacia

4. Werdnig-Hoffmann's Disease
(Infantile Spino-Bulbar Mus-
cular Artrophy).

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Work in progress

1. Experimental Studies of Cere-
brovascular Distribution in Periven-
tricular Zones. Injection studies em-
ploying the Schlesinger technique have
been started in an attempt to define
the vascular supply in the periventric-
ular zones of brain. The frequent
necrosis of white matter of the new-
born occurs in characteristic zones in
deep white matter. We postulate that
these lesions are related to the "border
zones" of the three major cerebral
vessels. However, proof of such is
lacking, because no investigations of
cerebral blood supply have included
these deep key zones. We shall also
attempt to demonstrate a difference in
vascularization of brain in the pre-
mature, newborn, and mature brains.

2. Dermatomyositis. A clinical-
pathological study of dermatomyositis
is in progress. The purpose of this
project is to study carefully the vascu-
lar factors in this disease and to define
accurately the pathological changes.
Material will be studied from children
dying before steroid therapy was em-
ployed as well as from those who have
had the benefit of such treatment.

Recommendations

1. More space. With the expan-
sion of this group, we are desperately
in need of more space. Our research
fellows have been working in a small
passageway (fire exit) next to the lab-
oratory, and in the slide file room.
These rooms have no ventilation in
the summer, are dark, and the passage-
way is cold and drafty in the winter
time.

2. The future. At the end of
three years of uninterrupted work in
the Neuropathology Laboratory, I do
not cease to be amazed at the wealth
of opportunity here for study, and the
challenge of studying diseases about

which nothing has heretofore been
learned.

THE RESEARCH DIVISION
OF INFECTIOUS DISEASES

Personnel

During this period the following in-
dividuals have participated regularly
in the work of the Division:

John F. Enders, Chief

Sidney Kibrick, M.D.
Research Associate

Samuel L. Katz, M.D.
Research Associate

Robert B. Berg, M.D.

Postdoctoral Research Fellow,
National Institutes of Health,
U.SP.H.S.

Melvin S. Rosenthal, M.D.

Postdoctoral Research Fellow,
National Institutes of Health,
U.S.P.H.S.

Marcel W. Pons, Ph.D.

Postdoctoral Research Fellow,
National Institutes of Health,
U.S.P.H.S.

James W. Mosley, M.D.

Communicable Disease Center,
U.S.P.H.S.

Ion Gresser, M.D.

Postdoctoral Research Fellow,
The National Foundation

Sumner Berkovich, M.D.

Postdoctoral Research Fellow,
The National Foundation

Edward De Maeyer, M.D.
Lederle International Fellow

Monto Ho, M.D.

Postdoctoral Research Fellow,
Jane Coffin Childs Memorial
Fund for Medical Research.
In addition, the following under-
graduates of the Harvard Medical
School as special students received
training in laboratory techniques and
methods of research:

Harvey Shein

John Bachman

Eliot Berson

Alan Cooper

Research

As in the immediate preceding years,
the research activities of the Division
may be roughly divided into the fol-
lowing categories:

Studies on the development of a
live attenuated virus vaccine
against measles.
Studies on virus-cell relationships.
Clinico-laboratory studies of pa-
tients with viral infections or
those suspected to have viral
infections.
Other investigations.
Measles Vaccine. Since our last report
covering the period January 1, 1958-
December 31, 1958, progress toward
the development of a measles vaccine
may be summarized as follows:

Two vaccines were prepared for
trial in susceptible children. These
consisted of active virus of the Ed-
monston strain attenuated by passage
in chick embryonic tissues as de-
scribed in a previous report. These
vaccines were designated vaccine A
and B respectively. The virus em-
ployed as vaccine A had received a
total of fifty-two consecutive passages
in cultures of human kidney and am-
nion cells, six passages in chick em-
bryos and fourteen passages in cul-
tures of chick embryo cells. Vaccine
B consisted of virus subjected to six
additional chick embryo passages and
four chick cell passages. Vaccine B
was prepared with the purpose of de-
termining whether additional passages
in chick cells might induce further
attenuation.

These vaccines have been tried in
children by various groups of investi-
gators located in different sections of
this country. The first trial was car-
ried out by Dr. Katz and Dr. Enders
in an institution for children located
in the vicinity of Boston. The results
of these trials, which have been pre-
sented in extenso in a series of papers

DIVISION OF LABORATORIES AND RESEARCH

published in the New England Jour-
nal of Medicine, may be summarized
as follows: A total of 303 children
received either vaccine A or vaccine
B. No difference in the intensity of
the clinical reactions were noted in
those receiving vaccine B as compared
with those in individuals receiving
vaccine A. Thirty-one children were
given the vaccine by the oral, intra-
nasal, or conjunctival routes. Nearly
all of these children failed to react to
vaccine. The remaining 272 children
received the vaccine subcutaneously.
One hundred seventy-one of these chil-
dren were considered to be susceptible
to measles on the basis of serologic
tests. Of these 165, or 96.5% subse-
quently developed antibodies against
the virus. Antibodies developing as a
result of vaccination have been shown
to persist for one and one half years in
satisfactory concentration in the first
group vaccinated.

Clinical responses following vac-
cination consisted of temperature ele-
vations, appearance of a modified rash
and in a few instances the presence of
koplik spots, mild conjunctivitis, and
slight coryza. Fever was recorded in
83 per cent of 171 children considered
to be susceptible and rash in 48 per
cent. The average maximal tempera-
ture (by rectum) was 102.4 degrees.
Malaise and prostration were in gen-
eral absent. Nearly all children con-
tinued their normal activities through-
out the post vaccinal period of three
weeks during which they were ob-
served. No complications attributable
to the vaccine were noted. Virus was
not recovered from the circulating
blood of those studied or from the
throat.

In essence, then, the vaccine was
found to induce a mild, much modi-
fied benign infection that results in a
prompt antibody response which tends
to persist.

Direct evidence for a high pro-
phylactic efficiency of the vaccine
within short periods after administra-
tion was obtained by certain of the
participating investigators. Dr. Saul
Krugman of the New York Univer-
sity School of Medicine reported com-
plete protection in a group of twenty-
three children vaccinated seven weeks
previously and naturally exposed to
measles in an institutional environ-
ment. Among a control group of
twenty-three unvaccinated children
housed in the same ward seventeen
developed measles. Lepow and her
associates in Cleveland and Haggerty
and his associates of The Children's
Hospital Medical Center in Boston
have followed twenty-one successfully
vaccinated children who had no evi-
dence of disease following intimate
exposure to siblings with natural
measles.

More recently the vaccine has
been administered by Dr. Harry
Shwachman of The Children's Hospi-
tal Medical Center, Boston, to about
fifty children with pancreatic fibrosis.
No severe reactions were observed in
any of these children although some
were in a debilitated condition result-
ing from chronic disease. This group
was selected because natural measles is
frequently followed by serious illness
in patients with pancreatic fibrosis.

Dr. Frederick Gibbs and Dr. Ira
M. Rosenthal in Chicago have taken
electroencephalograms on approxi-
mately forty children following vac-
cination. In only one child was devia-
tion from the normal pattern noted.
This individual was suffering from an
intercurrent respiratory infection. In
a larger group with natural measles
these workers found abnormal changes
in about one half the cases. These
negative findings in vaccinated chil-
dren therefore give some assurance
that the central nervous system is not

affected following vaccination.

In November I960 a small group
of children were vaccinated in West
Nigeria. In this country measles pre-
sents an acute problem because of
serious morbidity and significant mor-
tality which follows the disease, ap-
parently because many children suffer
from various bacterial, protozoal, and
helminthic infections and from mal-
nutrition. The trial was carried out by
Dr. Samuel L. Katz and Dr. David
Morley, pediatrician at the Wesley
Guild Hospital in Ilesha, West Ni-
geria. Final data are not yet available.
However, the clinical responses of
these children did not differ signifi-
cantly from those encountered with
the vaccine in this country. It is hoped
that arrangements can be made for
more extensive trials in this area, al-
though definite commitments have not
yet been made.

A number of American pharma-
ceutical companies and at least one
British firm are interested in the pos-
sibility of producing the attenuated
measles vaccine. Several have already
manufactured vaccines which are
under trial. Methods of freezing and
drying the vaccine with preservation
of viral activity have been developed
by some of these manufacturers which
will facilitate the distribution of vac-
cine on a large scale should this be
required in the future.

Studies on Virus-Cell Relationships
and on Biological Properties of
Viruses.

a) Interferon. An analysis of the
production and effect on interferon or
VIF ("viral inhibitory factor" as it is
termed in this laboratory) in tissue
cultures infected with measles and
poliovirus was completed by Dr. Ho
and the results published. Dr. De
Maeyer extended these findings in re-
spect to measles virus. He observed

PvEPORTS OF CHIEFS OF THE MEDICAL SERVICES

that in cultures infected with the at-
tenuated Edmonston strain the amount
of interferon produced is signficantly
greater than in cultures infected with
virulent measles virus. Similar differ-
ences in interferon production were
found in cultures infected with at-
tenuated (vaccine strains) poliovirus
and those infected with virulent
strains. These observations, if con-
firmed and extended, may serve to de-
fine one of the factors involved in
viral attenuation. This would be
helpful since the properties which de-
termine virulence or lack of it are
largely unknown. Such differences
may also be of practical significance
in affording additional "markers"
whereby variants in respect to viru-
lence can be distinguished.

b) Effect of Cortisone on in vitro
Viral Injection. In cultures infected
with an unidentified simian virus,
which under routine conditions of
cultivation produces slight cytopathic
effects, the addition of cortisone led to
the development of widespread cellu-
lar changes. This is the first instance,
so far as we are aware, that cortisone
in vitro has clearly enhanced the cyto-
pathic effect of a virus. Results have
recently been obtained suggesting that
cortisone may act in this way by sup-
pressing the production of interferon
in this system.

c) Multiplication of Measles
Virus in Blood Leucocytes. In at-
tempts to distinguish mechanisms that
may account for the leucopenia so
characteristic of many viral infections
experiments were undertaken to deter-
mine whether measles virus would
multiply in blood leucocytes. Berg
and Rosenthal found that this agent
proliferated actively in suspensions of
human and monkey leucocytes but not
in those of certain other species in-
susceptible to measles infection. Evi-
dence was obtained that viral multipli-

cation took place largely, if not en-
tirely, in monocytic cells.

d) Effect of Trypsin on Myxo-
viruses. Because of its possible value
as a criterion for the future classifica-
tion of viruses as well as possible ap-
plications to the study of viral struc-
ture a study of the effect of trypsin on
representative strains of myxoviruses
was carried out by Dr. Ion Gresser. Its
effect both on the infectivity and the
viral hemagglutinin were examined.
The results showed that these agents
could be separated into three groups
in accordance with the stability of
these two properties: one group in
which both properties were trypsin-
resistant, a second in which infec-
tivity was diminished but the hemag-
glutinin was unchanged and a third in
which both infectivity and hemagglu-
tinin were impaired.

e) Effect of pH and CO s Tension
on Infection of Cells by Viruses. Re-
search on the influence of these factors
on cellular infection and resistance is
currently in progress.

Clinico-lab oratory studies

a) Enteroviruses. Dr. Kibrick
and Dr. Berkovich have carried out
a virological and serological analysis
of 137 cases of paralytic poliomyelitis
occurring in this area in 1959. In all
these cases Type III poliovirus was
shown to be the responsible agent.
Nearly one half of these cases occurred
in children who had received three or
more doses of Salk vaccine. The re-
sults of this study indicate that the
incidence of paralytic disease in vac-
cinated individuals was significantly
higher than in the rest of the country
where the prevalent virus was polio
Type I. Serologic data were obtained
suggesting that the failures may have
been due to vaccine of low antigeni-
city since many of the cases exhibited
no neutralizing antibodies for Type J

virus. That failure of the host to re-
spond to an effective antigenic stimu-
lus was not responsible was indicated
by the prompt development of Type
III antibody during convalescence.

b) Respiratory Viruses. Dr. Kib-
rick continued the investigation of
cases in the hospital with respiratory
infections. In addition to the rather
frequent isolation of Group Associated
virus from patients of this class he has
recovered a number of agents which
have not yet been identified.

c) Viral Infections of the New-
born. Dr. Kibrick has also continued
to examine materials of clinical and
pathological interest from premature
and newborn infants to extend our
knowledge of disease due to viral
agents in this age group.

d) Completion of Studies on the
Etiology of Giant Cell Pneumonia.
Studies originally initiated by Doctors
Kevin McCarthy and William
Cheatham in 1955 on the role of
measles virus in Hecht's giant cell
pneumonia were extended and have
been completed by Dr. Anna Mitus
and her co-workers. The results have
been published. It was shown that
measles virus was responsible for the
cases of this disease from which
autopsy materials were available in
The Children's Hospital Medical Cen-
ter. Furthermore, in a correlated study
of pneumonia following measles in
leukemic children who were patients
in The Children's Cancer Foundation
clinic it was shown that the antibody
response was markedly depressed. As-
sociated with this effect was a persist-
ence of virus in the oropharynx be-
yond the normal limits.

e) Isolation of Measles from the
Urine. From six to eight patients with
naturally acquired measles, the virus
was isolated from the urine by Doc-

DIVISION OF LABORATORIES AND RESEARCH

tors Gresser and Katz. This is the
first time the virus has been demon-
strated in the urine. It is of interest
that in one case the agent was re-
covered from the urine four days after
the appearance of the rash. At this
time attempts by various workers to
demonstrate the agent in blood and
throat secretions have failed.

f ) Attempts to Cultivate the Vi-
rus of Infectious and Serum Hepatitis.
Dr. James W. Mosley of the Com-
municable Disease Center, U. S. Pub-
lic Health Service, has attempted to
demonstrate the multiplication of
these agents in various types of cul-
tures of human cells. As criterion for
viral multiplication it was considered
that output of transaminase by the
cells might become significantly al-
tered. Accordingly, Dr. Mosley per-
fected procedures for measuring these
enzymes in cell cultures and applied
them to a comparison of cultures
inoculated respectively with materials
considered to contain one of the two
hepatitis viruses. No effect on trans-
aminases (GOT and GPT) was ob-
served.

Other investigations

a) An Inhibitor of Ribonuclease
Activity. Dr. Marcel W. Pons investi-
gated various substances capable of in-
hibiting ribonuclease activity that
have been described in the literature
with the objective of determining
whether any could be employed in cell
cultures without injury to cellular ac-
tivity. The only material that ap-
peared to be at all promising was an
inhibitor derived from lilac leaves, de-
scribed by Bernheimer and Stack. As
prepared by them the substance was
mildly cyto-toxic. Dr. Pons devised a
method of purification of the lilac
leaf inhibitor which exhibits little or
no toxicity. He then found that the
inhibitor had no effect on the multi-

plication of poliovirus — an RNA vi-
rus — nor on measles virus. The inhibi-
tor proved useful in studies involving
the acridine orange staining of cells
since the loss of RNA staining due to
contaminating RNase in the prepara-
tions was prevented by treatment with
the inhibitor.

b) Possible Presence of RNA
Polymerizing Enzymes in Normal
Horse Serum. During the course of
investigation on the effect of various
ammonium sulphate fractions of horse
serum on ribonuclease activity of calf
amniotic fluid, Dr. Pons noted an ap-
parent increase of acid precipitable
RNA in systems containing RNase,
yeast RNA and the horse serum frac-
tion. Inhibition of RNase by lilac leaf
inhibitor prevented the apparent in-
crease in precipitable RNA. Although
the phosphorous in the precipitate was
increased, pentose, as measured by the
orcinol test, was not. The ultimate
significance of these findings remains
to be determined, but obviously if
polymerization of RNA subunits is in
the future clearly demonstrated under
these conditions, the findings would
be of much interest.

Honors. In 1959, Dr. Katz was
designated by the Boston Junior
Chamber of Commerce as one of the
outstanding young men of the year.
Dr. Enders received, in I960, an hon-
orary degree of Doctor of Science
from Tufts University and Doctor of
Humane Letters from the University
of Hartford. He was also awarded the
Cameron Prize in Practical Therapeu-
tics by the University of Edinburgh.

Publications. A list of papers written
by members of the Division as well as
those submitted for publication or in
preparation is appended. (See p. 109).

CLINICAL LABORATORIES

Harry Shwachman, M.D., Director
I960

Personnel

We have had a difficult time this past
year because of the shortage of trained
technicians. The turnover was some-
what greater than usual. The main
reason for the latter is marriage.

Miss Anne Rush, the head tech-
nician of our Hematology Laboratory,
left to be married and she was re-
placed by Mrs. Elaine Nelson, who
recently resigned because of preg-
nancy.

Miss Barbara Williams and Miss
Norma Baker continue as head tech-
nicians in Chemistry and Bacteriology,
respectively.

In attempting to replace our tech-
nicians, we have had assistance from
the Personnel Office. We recently sug-
gested that newspaper advertisements
be placed in order to fill vacancies.
Inasmuch as this is a problem common
to all our local hospitals, a farsighted
program might be considered which
would establish a school for techni-
cians. We have taken on a few in-
dividuals for training purposes be-
cause of need rather than a desire to
operate a school. The Planning Com-
mittee of the Hospital may consider,
with profit, the establishment of a
training school for laboratory tech-
nicians. In this connection, affiliation
with local colleges may provide the
pioper basic science background for
proposed students.

Night Coverage

In providing continuous twenty-four
hour service, we have had the assist-
ance of Harvard Medical School stu-
dents, who serve as technicians during
nights, weekends and holidays. This
arrangement continues to be satisfac-
tory. In view of the increased load of

100

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

work that has been requested of our
night technicians, many of our stu-
dents had to drop out. We have in-
creased coverage and have also made
the position financially more attractive
and in line with the opportunities the
medical students have in other institu-
tions in the city.

Physicians

We have suffered a sad loss in the
death of Dr. Eva Fekete, who worked
in the Bacteriology Laboratory on
problems concerned with hospital in-
fections and patients with cystic fibro-
sis. One of her recent achievements
was the demonstration by the Out-
cherony technique of the presence of
antibodies against Staphylococci in the
serum of a series of patients with cys-
tic fibrosis. She also demonstrated, for
the first time in this institution, the
presence of milk antibodies by the
above technique in the case of a
youngster who had chronic recurrent
pulmonary symptoms. The presence of
chronic pulmonary changes due to
milk and the demonstration of anti-
bodies to milk was pointed out by Dr.
Heiner, formerly of the Medical
Service. This one patient has shown
considerable improvement following
the removal of milk from the diet and
is being followed by Dr. Cook. Dr.
Fekete was assisting in the phage typ-
ing of Staphylococci and was be-
ginning to do special studies with the
Pseudomonas which is now the most
common terminal microorganism in
patients with cystic fibrosis.

Dr. Robert Rosan was a resident
in the clinical laboratory and left on
December 31, 1959, after completing
one and one-half years with us. He
was of considerable assistance while
he was in charge of the laboratory, and
in the clinical study of a selected
group of patients with nutritional dis-
turbances. Some of his investigative

work resulted in a study of cystic fi-
brosis patients from the point of view
of tocophorol deficiency. He also
worked on a small group of patients
with cystic fibrosis, who developed
diabetes. He performed tolbutamid
tolerance tests in this group of pa-
tients. We hope, in the near future,
to have some of his observations in-
corporated in a study of the complica-
tions of cystic fibrosis.

Dr. Lucas L. Kulczycki has been
primarily involved in the care of pa-
tients with cystic fibrosis and in the
clinical problems related to this dis-
ease. He is available to assist patients
who come here for laboratory tests,
and to lend a helping hand to any of
our technicians when so called upon.
His main income is derived from cys-
tic fibrosis research funds. He also
takes an active part in the Maine
Medical Center Cystic Fibrosis Clinic.

Dr. Ezra Elian, a Research Fellow,
left us in July I960 after spending
nineteen months with us. Dr. Elian
was recommended by Dr. Matoth, who
had formerly worked at The Chil-
dren's Hospital Medical Center and
now serves as his Chief in the Sharon
Hospital, Petsh Tikva, Israel. Dr.
Elian worked both in the clinic and in
the laboratory on a variety of prob-
lems. He was involved in chemical
studies of sweat, the study of meco-
nium, and in the development of im-
proved technique for sweat testing.
He also had an opportunity of learn-
ing a variety of laboratory procedures
and methods of investigation which I
think will be of considerable help to
him in his future work. He is a co-
author of two papers which have been
accepted for publication.

Dr. Sami Kassim came as a part-
time research fellow from Iraq. He
formerly worked with us and has been
familiar with the clinical management
of patients with cystic fibrosis. Now,

he spends half of his time with Dr.
Massell in the Rheumatic Fever
Clinic. His wife is a Doctor of
Astronomy at the Harvard Observa-
tory.

Dr. Kon-taik Khaw came to us on
July 1, I960 as a research fellow, after
completing a residence with Dr. Gellis
at the Boston City Hospital. He is of
considerable help to us in the manage-
ment of patients with cystic fibrosis,
and in the routine laboratory.

Dr. Mervin Silverberg spent from
July 1959 to December 31, 1959
working with us on the clinical prob-
lems seen in our Nutrition Clinic. In
addition to familiarizing himself with
our program, he and Dr. Elian joined
in carrying out an interesting clinical
problem. They reviewed our patients
with cystic fibrosis, who had previ-
ously been hospitalized at The Chil-
dren's Hospital and in whom the diag-
nosis had not been suspected during
hospitalization. Approximately twenty
such patients comprise the series. It
is our plan to broaden this project and
present a report on the uncommon or
previously unrecognized manifesta-
tions of cystic fibrosis. Dr. Silverberg
is now in Montreal in practice and
spending part of his time at The Chil-
dren's Hospital.

Dr. Maria Nicholaidou left us on
September 29, I960 for her home in
Athens, Greece, after spending two
years at this hospital. She spent ap-
proximately nine months with us. Her
studies on the amino acid content of
plasma and red cells was done in the
Laboratories of the Department of
Physical Chemistry at the Medical
School, in Dr. McMenamy's Labora-
tory. She has worked independently.
The source of her patients has been
The Children's Hospital and the Bos-
ton City Hospital. Dr. Nickolaidou
was exposed to our methods in the
clinical management and investigation

101

DIVISION OF LABORATORIES AND RESEARCH

of patients with cystic fibrosis and
celiac disease. She has high hopes of
continuing her studies in nutritional
problems when she returns home.

Nutrition Clinic

This clinic is designed primarily for
long-term follow-up of children who
have chronic nutrition problems. The
majority of patients seen in this clinic
are those having cystic fibrosis of the
pancreas, celiac disease, and conditions
resembling these diseases. In addition
there are a small number of children
with other metabolic or emotional
problems in which growth and nutri-
tion are affected. Between fifteen and
twenty patients are seen in the clinic
on each clinic morning. We now have
three rooms in the Medical Out-
Patient Department in which to see
our patients, and a large teaching
room, which, however, is not available
until approximately 9:30 A.M. Since
our clinic begins promptly at 9:00
there has been some unnecessary loss
of time. Furthermore, it is not con-
venient to interview two people in the
same large room. All in all, we are not
entirely happy with our present ar-
rangement, but we do understand the
crowded conditions and facilities of
the Medical Out-Patient Department.
It is a great advantage to have a clinic
where parents can come and discuss
their problems. This is not as readily
available as in our former quarters,
where a large room for such conversa-
tions could be had in semi-privacy.

The clinic patients are also seen,
from time to time, in our office area
because of the type of care children
with cystic fibrosis require. It is not
uncommon for patients to telephone
in for advice or to come and visit in
our office area when medical problems
arise. For patients for whom it is a
great hardship to come on Fridays, we
make special arrangements for one of

our Fellows to see these patients on
some morning during the week or on
Saturday mornings, if this will ease
the total family burden. We are for-
tunate in having a fairly large number
of our patients, approximately 240, en-
rolled in the State Aid Program (the
Crippled Children's Program of the
Maternal and Child Health). This
program provides antibiotics, either
free, which is the case in most of our
240 patients, or at a 50 per cent cost
to a small number of people with
moderate means and who could afford
to pay for this. In addition, the $6.00
clinic fee is paid to the hospital for
each visit. Short-term hospitalizations
are also provided by the State. My of-
fice secretary keeps a record of the
clinic visits and prepares a report for
Dr. Rafuse periodically. When this
program was started, approximately
three years ago, we were required to
write a brief report on each patient on
each clinic visit. This tremendous bur-
den has now been lightened so that we
now are required to submit the name
and date of each visit only. Resumes
of cases are provided whenever Dr.
Rafuse requests this information.

Our clinic offers an opportunity
for visiting physicians and parents
from other parts of the country to
learn more about the disease, cystic fi-
brosis. A number of pediatricians
have attended our clinic. Each patient
is checked thoroughly and we devote
approximately one hour per patient
visit. Patients are sent to our physio-
therapy department, as indicated. Spe-
cial observations are made in line with
some of our research activities.

Since April of this year we have
been able to inoculate our children
with Dr. Enders' measles vaccine. This
is rather an important prophylactic
procedure because the appearance of
measles in children with cystic fibrosis
may begin a downhill course. At the

time of this writing we have vac-
cinated at least fifty children with rela-
tively minimal reactions. Dr. Katz
acts as our consultant in this project.

We have also utilized some of
our clinic patients for our studies in
trying to develop improved techniques
for diagnosis and one of our current
projects is an attempt to use electrical
conductivity measurements from the
skin to determine if such a procedure
could be developed which would do
away with chemical analysis and pro-
vide a much quicker and perhaps a
better diagnostic test. This has not yet
proven successful. We have the as-
sistance of one of the scientists from
Baird Atomic working on this project
with us.

Other special projects in which
we have used the combined clinic and
research area for our studies includes
the following: the incidence of
diabetes in cystic fibrosis, the fre-
quency of allergy in a large group of
patients with cystic fibrosis, the rela-
tionship of nasal polyposis to cystic
fibrosis, and the secretory function of
the parotid glands.

We feel that laboratory investi-
gations form an intrinsic part in the
proper management and study of the
patients we see in our Nutrition
Clinic.

Maine Medical Center, Portland

A brief statement concerning the
Maine Medical Center is given be-
cause we provide the supervisory and
consultant staff. Nearly two years ago
a clinic was established at the Maine
Medical Center for the diagnosis and
treatment of patients with cystic fi-
brosis and related conditions. This
clinic is under the joint auspices of the
Center, the Maine State Health De-
partment, Division of Maternal and
Child Health (Dr. Ella Langer) and
the Maine Cystic Fibrosis Chapter.

102

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

The clinic meets once monthly and
more frequently, if necessary. The at-
tending staff consists of the local
pediatricians in the Portland area, in
addition to Dr. Kulczycki, one of our
Fellows and myself. Either Dr. Kul-
czycki or I supervise each clinic, with
an attendance of from twelve to six-
teen patients. I believe the roster of
cystic fibrosis patients in this clinic is
approximately sixty.

Lectures and Exhibits

1. American Academy of Pediatrics:
Annual Meeting, October 3-5,
1959. Address before the section
of allergy on cystic fibrosis on
October 4, 1959.

2. Massachusetts State Grange, Au-
ditorium, Springfield, October 28,
1959. Acceptance speech for
$7,000 contribution to cystic
fibrosis research at The Children's
Hospital Medical Center.

3. Attended Seventh Antibiotic Sym-
posium in Washington, D. C.
Mayflower Hotel. November 4-6,
1959.

4. Visiting Professor, University of
Puerto Rico, November 16-24,

1959. (A report on this experi-
ence submitted.)

5. Radio — National Hookup on
Cystic Fibrosis. February 11,

1960. Local Broadcast March 7,
I960.

6. Award and special honors. Feb-
ruary 13, 1960. Rhode Island
Chapter of Cystic Fibrosis.

7. Attended National Cystic Fibrosis
Research Foundation meeting
(Executives) in New York,
March 10, I960.

Presented report of Education
Committee.
H. New England Society of Allergy,
March 30, I960,
(a) Respiratory Allergy in Pa-

tients with Cystic Fibrosis —

Dr. Kulczycki.
(b) Technique and Results of

Sweat Analysis — Dr. Shwach-

man.
9. Evening speaker, Massachusetts
CF. Chapter — April 2, I960.
Evening speaker, Rhode Island
CF. Chapter — April 30, I960.
Evening speaker, Connecticut
CF. Chapter — May 14, I960.
Topic: Current Research in Cystic
Fibrosis.

10. Academy of Medicine, Cleveland,
Ohio.

Evening address on Cystic Fibro-
sis— April 15, 1960.
Afternoon — member of panel on
cystic fibrosis.

11. Society for Pediatric Research,
Swampscott, May 2 and 3, I960.
Participated in an all-day infor-
mal session on cystic fibrosis:
paper given from workers in
U.S. and Canada.

12. 69th Annual Meeting of Arizona
Medical Association, Scottsdale,
Arizona, May 4 to May 7, I960.
Papers on

(1) Staphylococcal Infections in
Childhood.

(2) Malnutrition in Childhood,
on panel on Psychiatry in
General Practice and the
Specialties.

13. Symposium on the Pancreas:
Endicott House, Dedham, Mass.
Chairman — Dr. Sidney Farber.
Secretary — Dr. Shields Warren.
Participant, May 23-25, I960.

14. Central Maine General Hospital,
Lewiston, June 8, I960. The
Clinical Laboratory — New Tests
and Interpretations of Laboratory
Data.

Other Lectures

1. Occasional A.M. lecture in M.O.-
P.D., Surgical and Orthopedic

rounds and consultations.

2. One Hour Lecture — 4 to 5 times
during the year to nurses (Chil-
dren's Hospital School of Nursing)
on Cystic Fibrosis and Celiac
Disease.

3. Participation in organization and
teaching of a one- week course
(three given to date) for physio-
therapists in the management of
patients with cystic fibrosis. This
course under auspices of our own
Physiotherapy Department ( Miss
Cogland and Mrs. Zausmer).

4. Occasional lectures to Postgradu-
ate students.

5. Clinics or lectures in neighboring
hospitals, such as:

CP.C at Boston Floating Hospital,

1-18-60.
P.B.B.H. Grand Rounds, 3-18-60.
B.I. Lectures, 4-18-60.
Joslin Clinic, Lectures. Diabetes

in Cystic Fibrosis, 1-25-60
M.G.H. Informal discussion with

G.I. group, 3-21-60
B.L.I., CP.C, February 10, I960.
North Shore Babies Hospital,

Rounds, 2-15-60.

Other Activities

Member, Committee on Tuber-
culosis and Respiratory Diseases in
Children, American Trudeau Society.
One year, 1959-60.

Consultant, Pediatrics. Chelsea
Naval Hospital. Seven visits per year.

Secretary-Treasurer, New England
Pediatric Society.

Re-elected to office, 1960-1961.

Chairman — Education Committee
National Cystic Fibrosis Research
Foundation.

During the year received manu-
scripts from a number of editors, re-
questing opinion.

Laboratory Equipment

At the present time we are moderately
well equipped. We can foresee need

103

DIVISION OF LABORATORIES AND RESEARCH

for the Technicon Auto-analyzer,
which will yield more reproducible
results and will undoubtedly save tech-
nician time if the volume of any one
test is sufficiently great. At the present
time it is estimated that the installa-
tion of such an instrument will cost
approximately $5,000. Once installed,
such an instrument will process well
over 100 determinations in one half
day. Most of the major hospitals in
this area already have one instrument
and some, two. The volume of any
one test in our laboratory is perhaps
not sufficiently great to justify this
expenditure at this time. However, if
one or more determinations could be
done, and if the volume of work is
sufficiendy great, the acquisition of
such an instrument will prove an eco-
nomic advantage by elimination of one
technician and by providing more con-
stant uniform results than is possible
by individual analysis by a variety of
technicians.

During this past year we have ac-
quired a micro Beckman Spinco ana-
lyzer, which is being explored for
adaptation to the micro analyses of
serum specimens. We have not yet
utilized this instrument routinely, as
it is still in the process of exploratory
usage.

The main chemistry laboratory ap-
pears to be fairly well equipped and
at present the only exception is the
probable need for a new centrifuge
this coming year as the current ma-
chines are very old and have been re-
paired so often that we have been
advised that they will probably not
last too much longer. One of our
chemistry laboratories is in need of
modernization and perhaps in the near
future a plan can be worked out for
this laboratory, which is room 3210.

One of the problems that has re-
cently come to our attention is stand-
ardization of bilirubins.

The bacteriology laboratory is, in-
deed, cramped, and we are bursting
at the seams. We are fortunate in
having space made available in the
Jimmy Fund Building for our entire
phage typing program. Even here, at
times, the space has been limited. We
are in dire need of adequate laboratory
space for the routine bacteriology lab-
oratory. I should like to point out
that the amount of work has increased
tremendously in this laboratory over
the past four years. There is serious
need for a highly competent profes-
sional bacteriologist to conduct the
routine studies in this most important
field. The lives of our patients liter-
ally depend upon the quality of the
work in this laboratory. The volume
of work has so grown that more expert
help is essential.

We continue to participate in the
State Approval Program and have re-
ceived excellent reports from the State
Laboratories concerning the identifica-
tion of unknown specimens in a vari-
ety of categories. This voluntary par-
ticipation provides us with an ap-
proval certificate which must be earned
anew.

The hematology laboratory is
grossly inadequate in size for the num-
ber of people working in it.

The volume of work has increased
again. The total number of individual
tests is 159,317 — or four times the
number carried our in the same space
ten years ago!

REPORT OF RESEARCH PROGRAM

Conducted Jointly by the Departments
of Orthopedic Surgery and Pathology of
The Children's Hospital Medical Cen-
ter and The Children's Cancer Re-
search Foundation.

By Dr. Jonathan Cohen, under the
responsibility of Dr. William T. Green,
with the cooperation of Dr. Sidney
Farber.

Personnel and Facilities

During the present reporting period,
many changes in personnel have taken
place. John Burke continues to sup-
ply outstanding technical, historical
preparations. Animal care has been
resumed under the direction of Cor-
nelius Vos and has, therefore, been
somewhat better than during the pre-
vious period when his services were
devoted entirely to other laboratories.
However, animal care has remained
a problem because of specialized needs
of some animals under investigation
with special techniques. The entire
personnel of the laboratory, including
secretary, technicians, and investiga-
tive personnel, have collaborated to
meet these needs, and this has worked
out well.

During the period of the present
report, only two residents have been
assigned for duty in the laboratory,
in addition to Dr. Marvin Weinfeld,
mentioned in the previous report.
They are Dr. Arthur Pappas, who en-
ters on a period of between eight and
twelve months of laboratory service
designed to provide him with basic
science training and also to continue
his investigative work, started at the
National Institutes of Health. There,
he was occupied with the problems
of total body radiation and some prob-
lems involving tissue culture of cells
for the purpose of studying radiation.
His immediate supervisor at the Na-
tional Institutes of Health was Dr.
Hyatt, who is in charge of the tissue
bank at the Naval Medical School.
Another resident who has begun his
period of service in this laboratory is
Dr. Seymour Zimbler, who is to serve
from July 1 to December 31, I960.
Dr. Zimbler 's period in the laboratory
is to be devoted to study of basic sci-
ence in preparation for his orthopedic
training.

104

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

With relation to the study on the
Assay of Foreign Body Reactions, the
employment of Mrs. Vida Barrs as a
chemistry technician, has been a sta-
bilizing influence on the needed chem-
ical work done with relation to that
program. Analyses for chromium,
nickel, and molybdenum are now per-
formed in routine fashion on many
specimens as will be detailed below.
Further elaboration of analyses on
other elements in the metallic objects
under investigation will be her prin-
cipal methodological occupation in
addition to the routines. Professor
Licht mentioned in the previous re-
port, has provided some of the con-
sultation in chemistry which has been
needed and in addition, the Chemistry
Department at the Watertown Arsenal,
in which Professor Licht and Bernard
Mahoney, a previous employee of this
project, have been active, are also now
serving in that capacity. The collabo-
ration of this laboratory has continued
with the Radioactivity Center of the
Department of Biophysics at M. I. T.
(Dr. Robley Evans, Director) and
with Dr. Constantine J. Maletskos of
the Nuclear Reactor Laboratory, but
more recently appointed to the Radio-
activity Center. One of the achieve-
ments of this collaboration has been
the preparation of the report men-
tioned below, and the furthering of
the radium toxicity investigation now
proceeding at the M. I. T. facilities.

The control panel of the build-
ing, having been finished during the
period of the last report, the person-
nel have enjoyed quiet working con-
ditions during the period of this re-
port. However, the prospect of new
quarters elsewhere in the present build-
ing has influenced greatly the plans of
this laboratory, which are being ex-
panded but with indefinite goals both
as to space and time because of the
lack of concrete knowledge as to when

the new quarters will be available and
how large they will be.

The Saltonstall Laboratory in the
main building of the hospital has con-
tinued to serve well with regard to
electromyography and histological
studies.

Work in Progress

1. Radioactive Calcium Tracer
Studies. The previously mentioned col-
laboration with Dr. John Marshall of
the Argonne National Laboratory has
been completed and the publications
listed below are the final results of
this collaboration.

2. The Dynamics of Strontium
and Calcium Metabolism and Radio-
element Removal. This study has
seen publication as listed below, and
no further work in this area is con-
templated. However, a large amount
of data previously accumulated in col-
laboration with Dr. Maletskos, and
which formed the basis of a publica-
tion in 1957, but which was not in-
cluded in that publication, has been
revived for the purposes of a presenta-
tion at a Symposium of the Interna-
tional Society of Traumatology and
Orthopedic Surgery to be held at
Princeton from August 29 to Septem-
ber 3, I960. The data, which related
to the use of Ca 48 in the study of the
disposition of bone grafts, proved of
more general interest with respect to
calcium metabolism and kinetics than
to the graft problem. A differentia-
tion between the puppies and dogs
used in this experiment was easily
made on the basis of serum levels of
calcium and bone retention of cal-
cium. This work has relevance to the
problem of retention of radioactive
isotopes in bone. It will be published
in its entirety in the Proceedings of
the meeting, which will include dis-
cussions by twenty panel participants.

3. Cathode Irradiation of Bone

for Sterilization. This procedure de-
veloped in this laboratory for use to
supplement the sterile operative re-
frigerated material available for clin-
ical bone grafting, has been in opera-
tion now for 5 years with no single
failure attributable to the technique
of preparation of the graft. Clinical
failures of grafting procedure have not
been recorded during this period and,
therefore, although actual instances of
failure of a minor type may have
occurred, certainly no major failures
are in evidence. It is impossible at
the present time to make proper clin-
ical evaluation of the material with
relation to the degrees of clinical suc-
cess, although no evidences of infec-
tion or of undue disappearance of
grafted materials have been evident.
The procedure continues to be taken
up by a number of institutions else-
where in this country and abroad, and
one of our former residents now in
Athens, Greece, has begun to use the
method under our supervision.

4. Foreign Body Study. A precept
that foreign material is entirely inert
when imbedded in tissues has been the
fundamental one in this study. This
has been further confirmed and am-
plified as a result of the work done
during the last year in this depart-
ment and has now achieved general
acceptance. Given a large enough sur-
face exposure to tissues, any material
will cause appreciable tissue reaction.
The preliminary experiments which
were described in the previous report,
and which concerned weight loss of
objects of different metallic composi-
tion when placed in different solutions
under different gas liquid conditions,
have been completed. None of these
showed a consequential pattern of cor-
rosion or weight loss and, therefore,
these studies have been discontinued.
To further the pursuit of the prob-
lem of corrosion in metallic implants,

105

DIVISION OF LABORATORIES AND RESEARCH

in vitro studies were devised where
such metallic objects were placed un-
der cyclic stress for long periods. This
type of experiment was mentioned in
the previous report as of a prelimin-
ary nature, but in this report the con-
clusion of several of these experiments
have yielded definitive evidence that
under these conditions of very slight
cyclic stress, certain batches of metal
will show marked corrosion, where in
static solutions no corrosion was de-
monstrable. These experiments are
now being written up and will be
available shortly as a definitive paper.

The study of foreign body reaction
in clinical materials which have been
removed for one reason or another
after implantation principally for frac-
ture treatment, has become one of the
principal studies of this laboratory.
Over 180 of such devices are under
active investigation at the present
time. A further report of an instance
of metallic failure of this type is being
submitted to the Journal of Bone and
Joint Surgery for publication, and in-
dicates the type of investigations being
followed. The author of this report
continues his functions with regard to
the national needs of the profession
with regard to testing, regulation, and
evaluation of metallic implants, which
is under the supervision of the Bio-
Mechanics Committee of the American
Academy of Orthopedic Surgery. Ac-
tive collaboration with the United
States Pharmocopeia is being devel-
oped in order to bring out some
standards for these materials. Official
evaluation of failures submitted to the
Academy is being done. A course is
being given at the Academy Conven-
tion every year to provide interested
individuals with the details of the
problems of metallic implants.

The functions of regulation of
implants, principally directed at metal-
lic objects, has been expanded under

the Bio-Mechanics Committee juris-
diction to include plastics. An ex-
ample of the problems and occupa-
tions of this laboratory with this
material is evidenced by the recent
furor over the clinical results obtained
with a polyorithane plastic, commer-
cially obtainable as Ostamer. The
author of the present report, then a
member of the Orthopedic Research
Society Program Committee, was in-
strumental in having this material
evaluated and investigated. The nu-
merous clinical failures which have
been encountered have called for much
more careful investigative work with
such materials before they are released
for public use. The manner of control
of such release of materials is now
under active investigation as indicated
above, and it is hoped that the United
States Pharmocopeia and/or the Food
and Drug Administration will take the
first steps toward official requirements
concerning labelling, toxicology, etc.

Haversian System Study. This
study has been almost entirely in
abeyance during the period of this re-
port, owing to the lack of resident
help and interest in this subject. How-
ever, during the recent months just
prior to the above date, a resumption
of this study is being begun with the
idea of learning about the recruitment
of cells during the establishment of
new haversian systems. The pressure
studies mentioned in the previous re-
port are still considered promising but
are not being followed up for lack of
personnel.

Muscular Dystrophy. The clini-
cal work pertaining to muscular dys-
trophy and allied neuro-muscular con-
ditions has progressed about at the same
level during this period as previously.
The patients who attend the muscular
dystrophy clinic have continued to do
so. The mechanical advantages pro-
vided by the Surgical Appliance Shop

have been extremely helpful and the
summer camp facilities, previously in-
stituted by this clinic with the col-
laboration of one of the muscular dys-
trophy organizations, has proved im-
mensely beneficial to many patients.

The electromyography service has
continued to be rendered to The Chil-
dren's Hospital and to the Peter Bent
Brigham Hospital without charge.

The study of muscle function and
weight after removal of several
muscles has been completed and is the
subject of the report listed below.

A study of the characteristics of
the fluid from bone cysts has been
completed and published. This study
provides data relative to the patho-
physiology of cysts and from them a
theory of pathogenesis has been sug-
gested.

Miscellany

One case report mentioned in the pre-
vious Annual Progress Report has
been published as listed below, and
another has been submitted to the
Journal of Radiology for consideration
of publication. The activities of this
laboratory also include several ad-
ministrative and professional duties as-
sociated with the duties of Dr. Cohen
as follows:

1. Committee on Bio-Mechanics
and Metallic Implants, American
Academy of Orthopedic Surgery.

2. Committee on Pathology, ibid.

3. Committee on Scientific In-
vestigation, ibid.

4. Chairman, Program Commit-
tee, Orthopedic Research Society.

5. Program Committee, Gordon
Research Society, Conference on Bones
and Teeth.

6. Assistant Editor, Journal of
Bone and Joint Surgery.

New Work Begun During the
Interval Covered by This Report

First, a collaborative study with Dr.

106

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Giulio J. D'Angio of the Department
of Radiology has been begun, compar-
ing the types of disturbance of bone
which will be encountered when equal
amounts of radiation of X-ray or of
cathode ray are administered to rab-
bits. Second, another investigation of
the localized epiphyseal effects of
radiation administered to small and to
large volumes of tissue around epiphy-
ses has been begun with Dr. Arthur
Pappas. Third, an investigation of the
effects in tissue culture of small metal-
lic particles has been begun with Dr.
Pappas. Fourth, a study of the effects
on bone healing of radiation has also
been begun. Fifth, a study of the pat-
tern of growth of mouse and rat skulls
is being started, in collaboration with
Dr. Seymour Zimbler.

THE CHILDREN'S CANCER
RESEARCH FOUNDATION

This institution is affiliated with The
Children's Hospital Medical Center.
It was an outgrowth of the Depart-
ment of Pathology and most of the
members of the staff hold appoint-
ments in the Department of Pathology
of the Medical Center. The clinical
division of the Foundation is affiliated
closely with the clinical divisions of
the Hospital.

The Foundation laboratories rep-
resent a unique development. Their
highly specialized facilities and funda-
mental research programs are available
to all members of the staff of the
Medical Center. The laboratories are
open to medical students and to care-
fully selected high school and college
students for research. The expert staff
consists of scientists and medical doc-
tors with training in Physics, Chemis-
try and Biology. Their activities con-
stitute programs of research which
give a particularly broad and stimulat-
ing definition to the term "Experi-
mental Pathology."

A complete report of the activi-
ties of The Children's Cancer Research
Foundation is being prepared by the
Foundation. There is included here
only brief mention of representative
programs. No description is made of
the clinical program of care and in-
vestigation of leukemia and other
forms of disseminated cancer in the
young. This was the first program of
its kind, and it remains the largest
and most complete clinical unit in the
field of childhood cancer in the world.
More than 450 children at a time, with
disseminated cancer, receive new
treatments, proved in the laboratories,
as part of their total care. The discov-
ery of the first antimetabolite — a
chemical agent — for the temporary
control of acute leukemia, by Dr. Far-
ber in 1947, marked the beginning of
the era of antimetabolite cancer
chemotherapy. Many forms of cancer
in children have been controlled for
months and years, and, in a small
number, for as long as twelve years,
by chemicals first used here.

There may be mentioned, as an
example of this program, a promising
development which emanated from
the demonstration by Dr. Farber in
1954 of anti-cancer properties of
Actinomycin D, an antibiotic dis-
covered by Dr. Selman Waksman, in
1940. In observations made by Dr.
Farber and members of his staff, in-
cluding Dr. Audrey E. Evans and Dr.
Anna Mitus, in collaboration with Dr.
Giulio J. D'Angio of the Department
of Radiology, Actinomycin D was
shown to increase the usefulness of
small doses of X-ray against the com-
mon kidney tumor of children, the
Wilms' tumor, even after it had spread
to the lungs. The lives of such chil-
dren have been prolonged up to four
years with no evidence of return of the
scattered tumors, under a combination
of treatment by this antibiotic and

small doses of X-ray. The important
contributions of the surgeons, mainly
at The Children's Hospital Medical
Center, in the surgical treatment of
Wilms' tumor, had made possible the
survival of more than 40 per cent of
children suffering from this tumor.
With the addition of chemical treat-
ment to surgery, and radiotherapy
from the time of first discovery of the
tumor, the survival rate has increased
markedly. A careful study of the long-
term survival of patients so treated is
now under way. It appears that for
the first time there is a form of treat-
ment for even widespread Wilms'
tumor which has promise of being
specific, and perhaps curative. Lab-
oratory studies by Dr. D'Angio of the
Department of Radiology and the
Foundation, and members of the
Foundation staff, including Drs. Char-
lotte L. Maddock and Alfred H.
Handler, are clarifying the mechanism
of action of this antibiotic and are out-
lining the possible fields of further
usefulness in patients.

Laboratories of Organic Chemistry,
under the direction of Dr. Edward J.
Modest. Here a pioneer program in
the synthesis of anti-cancer chemicals
has been going on since 1958. More
than 300 new chemical compounds
have been created. Some of these have
had scientific interest in the field of in-
fectious disease research and para-
sitology, as well as cancer.

Laboratory of Enzyme Chemistry,
under the direction of Dr. S.-C. J. Fu.
Fundamental studies on the mecha-
nism of action of folic acid antagonists,
of basic importance in the problem of
acute leukemia in children, are in
progress.

Laboratories of Polypeptide Chemis-
try, under the direction of Dr. Elkan
R.. Blout and Dr. Gerald D. Fasman.
This laboratory is concerned with the

107

DIVISION OF LABORATORIES AND RESEARCH

synthesis of large molecular polypep-
tides of possible importance as plasma
expanders. These laboratories have
pioneered in the development of arti-
ficial materials which may act as
artificial enzymes or portions of arti-
ficial proteins. This is one of the two
great laboratories in the world in this
difficult new field of Chemistry.

Laboratories of Pharmacology, under
the direction of Dr. Marian F. Narrod.
This laboratory is concerned chiefly
with the action and toxicity of drugs
which are studied by laboratory
methods before they are employed in
the treatment of patients with dis-
seminated cancer.

Laboratory of Bacterial Metabolism
and Cell Biology, under the direction
of Dr. George E. Foley. This is one of
the first laboratories of this kind, and
has participated in the creation of a
whole new field of experimental bi-
ology. More than 60 kinds of human
cancer are grown in bottles in tissue
culture. Expert consultation in bac-
teriology is available to the hospital
from this group of experts.

Laboratories of Experimental Biology
and Transplantation, under the direc-
tion of Dr. Alfred H. Handler and Dr.
Richard A. Adams. In this laboratory
the pioneer work of Dr. Handler is
carried out under ideal conditions for
the growth of many types of human
cancer in the cheek pouch of the ham-
ster. Fundamental studies on the ef-
fect of chemicals under these condi-
tions, and the research concerning
causation of cancer represent contribu-
tions of major importance.

Laboratories of Mechanism of Bleed-
ing. Here Dr. Isaac Djerassi and Dr.
Edmund Klein conduct a large pro-
gram of research concerning the na-
ture of bleeding in acute leukemia and
after destruction of the marrow by

ionizing radiation. They are concerned
with a search for methods of protec-
tion, prevention, and adequate treat-
ment of massive hemorrhage.

Laboratories of Experimental Hema-
tology, under the direction of Dr.
Giuseppe Cardinali. The mechanism
of action of chemical compounds on
cancer cells is studied to give informa-
tion of basic importance in the ad-
ministration of anti-leukemic agents.

Laboratories of Genetics, under the di-
rection of Dr. George Yerganian.
These laboratories have acted not only
as a research center in the field of ani-
mal genetics, but also as a training
ground for scientists responsible for a
large part of genetic research in this
part of the country.

Laboratory of Experimental Pathology
and Cytochemistry, under the direc-
tion of Dr. Cecilie Leuchtenberger and
Dr. Rudolf Leuchtenberger. This has
been concerned with the possible role
of viruses as causative agents of can-
cer, as well as with fundamental cell
biology.

Laboratory of Experimental Botany,
Dr. Carl R. Partanen. Pioneer studies
on the nature of cancer produced in
fern, yielding information of impor-
tance to cancer chemotherapy in man,
have been conducted here for the past
three years.

Laboratories of Biophysics and Crystal-
lography. Here Dr. Carolyn Cohen,
Dr. Donald L. D. Caspar, and Dr.
Susan Lowey are conducting studies on
the structure of proteins of viruses and
the structure of muscle protein, by
technics which they are developing as
they pursue their fundamental studies
in one of the newest and most promis-
ing fields of medical science.

Laboratory of Tissue Ultras tructure.
Dr. Betty Uzman is continuing her

basic contribution to the study of mye-
lin sheath of the central nervous sys-
tem, as well as of the peripheral
nerves. Her studies have already given
the stimulus for a new attack on multi-
ple sclerosis and other diseases of the
nervous system.

Laboratories of Experimental Cancer
Chemotherapy, under Dr. Charlotte L.
Maddock. Our first macrobiological
studies of the effect of chemical com-
pounds on cancer are made on the
mouse. There is an extensive and ex-
pert pioneer program of experimental
cancer chemotherapy.

Laboratories of Enzyme Chemistry,
under Dr. Morris N. Green and Dr.
John T. Clarke. These laboratories
work in conjunction with the Clinical
Laboratories of Dr. Harry Shwachman,
on studies of fundamental importance
in the problems of cystic fibrosis.

Laboratories of Immunochemistry,
under Dr. Saul Malkiel. This labora-
tory is concerned with the immuno-
logical basis of infectious disease and
of certain cancers.

Laboratory of Biochemistry, under
Dr. Adele Magasanik. This laboratory
has been concerned, for the past nine
years, first under Dr. Zelma Miller and
then under Dr. Magasanik, with funda-
mental metabolic studies of basis im-
portance to our knowledge of the nor-
mal cell and of the cancer cell.

Laboratory of Lipid Chemistry and
Studies of Lipidosis, under Dr. Allen
C. Crocker. As part of a therapeutic
attack on the problem of incurable
disorders of heredito-familial nature,
carried out by Dr. Farber and by Dr.
Crocker, a Laboratory of Lipid Chemis-
try has been set up under the immedi-
ate direction of Dr. Crocker. Here
facilities are available for more com-
plete studies of the nature of these dis-
orders in children than were ever pos-

108

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

sible before. In addition, Dr. Crocker
is directing his research to a basic
understanding of the abnormal bio-
chemical mechanisms within cells
which are responsible for the devastat-
ing effect upon the brain and organs
of the body in these diseases.

Sidney Farber, M. D.,

Chairman,

Division of Laboratories and Research

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Green, M. N., Yerganian, G., and
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RESEARCH DIVISION OF
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Mosley, J. W, Dull, H. B., Doege,
T. C, and Kuykendall, H. D., Ele-
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Coelho, R. S., Goodman, J. W., and
Bowers, M. B., Chemical studies of
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Foley, G E., Drolet, B. P., McCarthy,
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Foley, G E., Friedman, O. M., and
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Karnovsky, M. J., and Fasman, G D.,
Histochemical method for distin-
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groups of proteins. /. Biopbys. &
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Katchalski, E., Fasman, G D., Simons,
E., and Blout, E. R., Synthetic
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to mammotropes, II. Hormone re-
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103:643, I960.

, Relation of mammotropes to

mammary tumors, IV. Development
of highly hormone dependent mam-
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& Med., 103:490, I960.

Kim, V., Furth, J., and Clifton, K. H,
Relation of mammary tumors to
mammotropes, III. Hormone re-
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mary tumors. Proc Soc. Exp. Biol.
& Med., 103:646, I960.

Kim, V., Clifton, K. H., and Furth, J.,
Highly inbred line of Wistar rats
yielding spontaneous mammo-soma-
totropic pituitary and other tumors.
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Klug, A., and Casper, D. L. D., Struc-
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Ill

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in Virus Research, Vol. 7. Academic
Press, I960.

Leuchtenberger, C. L., Relation of the
deoxyribosenucleic acid (DNA) of
sperm cells to fertility. 7- Dairy Sci.
(Suppl.) 43:31, I960.

and Leuchtenberger, R.,

Quantitative cytochemical studies on
the relation of deoxyribonucleic acid
of cells to various pathological con-
ditions. Biochem. Pharm., 4:128,
1960.

-, Deoxyribonucleic acid (DNA)

variations in neoplastic and virus-
infected cells. A cytochemical and
cytopathological study. Cell Physi-
ology of Neoplasia. University of
Texas, I960.

Leuchtenberger, C. L., Leuchenberger,
R, Zebrun, W., and Shaffer, P.,
Correlated histological, cytological
and cytochemical study of the
tracheobronchial tree and lungs of
mice exposed to cigarette smoke, II.
Cancer, 13:721, I960.

Leuchtenberger, R., Leuchtenberger,
C, Zebrun, W., and Shaffer, P.,
Correlated histological, cytological
and cytochemical study of the
tracheobronchial tree and lungs of
mice exposed to cigarette smoke, III.
Cancer, 13:9%, I960.

Maddock, C. L., D'Angio, G. J., Farber,
S., and Handler, A. H., Biological
studies of actinomycin D. Ann.
N. Y. Acad. Sci., 89:386, I960

Magasanik, A. K., and Bojarska, A.,
Enzyme induction and repression by
glucose in Aerobacter aerogenes.
Biochem. Biophys. Res. Commun.,
2:11, I960.

Meier, H., Diabetes mellitus in animals.
Diabetes, 9:485, I960.

and Brown, B. L., Protective

action of irradiated bone marrow
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145, I960.

, A "runt disease" syndrome

anemia and splenomegaly. /. Im-
munol. (In press.)

Mitus, A., Leuchtenberger, C, Leuch-
tenberger, R., and Enders, J. F.,
Further studies of giant cell
pneumonia (abstract). Am. J. Dis.
Child., 100:615, I960.

Modest, E. J., Foley, G. E., and Farber,
S., Derivatives of 2, 4-diaminopy-
rimidine as growth inhibitors. Extrait
de Acta Union Internationale Contre
le Cancer, xvi:10l, I960.

Partanen, C. R., Amino acid suppres-
sion of radiation-induced tumoriza-
tion in fern prothalli. Science, 131:
926, I960.

, Amino acid suppression of

radiation-induced tumorization of
fern prothalli. Proc. Nat. Acad. Sci.,
46:1206, 1960.

-, Endomitosis in a polyploid

associated with immunohemolytic

series of fern prothalli. /. Heredity.
(In press.)

Simmons, N. S., and Blout, E. R.,
Structure of tobacco mosaic virus
and its components: ultraviolet
optical rotatory dispersion. Biophys.
J., 1:55, 1960.

Steinberg, A. G, Genetics of acute
leukemia in children. Cancer, 13:
985, 1960.

Swaffield, M. N., and Foley, G. E.,
Changes in the cellular content of
ribonucleic acid, deoxyribonucleic
acid and protein in cultured cells
during logarithmic growth. Arch.
Biochem. & Biophys., 86:219, I960.

Uzman, B. G, and Villegas, G. M.,
Comparison of nodes of Ranvier in
sciatic nerves with node-like struc-
tures in optic nerves of the mouse.
7. Biophys. & Biochem. Cytol., 7:761,
I960.

Wetlaufer, D. W., On terminology of
protein structure. /. Am. Chem. Soc.
(In press.)

and Edsall, J. T., Sedimenta-
tion of myosin in urea solutions.

Biochem. Biophys. Acta, 43:132,
1960.

White, L. P., Influence of pH on the
toxicity of nitrogen mustard. Science,
131:1041, I960.

, Linden, G, Breslow, L., and

Harzfeld, L., Studies on melanoma,
III. Effect of pregnancy on survival
in human melanoma. J.A.M.A. (In
press.)

Yerganian, G, "Brittle-bristle": a sex-
limited factor affecting only the
female Chinese hamster, Cricetulus
griseus. J. Heredity. (In press.)

, Chromosomes of the Chinese

hamster, Cricetulus griseus, 1. The
normal complement and identifica-
tion of sex chromosomes. Int. J.
Cytol. (In press.)

-, Cytogenetic analysis with

reference to somatic cell genetics
in vitro. Genetics Study Section and
Division of General Medical Sci-
ences, National Institutes of Health.
(In press.)
, Radiation effects on mam-

malian sex chromosomes. Rod. Res.,
12:185, 1960.

-, Farber, S., and Gagnon, H.,

Spontaneous hereditary diabetes
mellitus in the Chinese hamster
(Cricetulus griseus), IV. Probable
inheritance pattern and the onset of
symptoms. Diabetes. (In press.)

Yerganian, G, Kato, R., Leonard, M.
J., Gagnon, H. J., and Grodzins, L.
A., Sex chromosomes in malignancy,
transplantability of growths, and
aberrant sex determination. In Cell
Physiology of Neoplasia. University
of Texas, I960.

Yerganian, G, Leonard, M. J., and
Gagnon, H. J., Chromosomes of the
Chinese hamster, Cricetulus griseus,
II. Onset of malignant transforma-
tion in vitro and the appearance of
the xi-chromosome. Pathol, et Biol.
(In press.)

112

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

Abstracts of Papers Presented at
Meetings

American Society for Experimental

Pathology — April I960.

Leuchtenberger, C, Stewart, S., Leuch-
tenberger, R., and Eddy, B., Corre-
lated microscopic and microspectro-
photometric studies of DNA of
tissues from mice and hamsters in-
fected with polyoma virus.

Maddock, C. L., Brown, B., DAngio,
G. J., and Tedeschi, C, Histological
studies of potentiation of x-ray ef-
fects by actinomycin D on skin of
normal mice.

McCarthy, R. E., Modification of the
homograft response in mice by
ascites.

Narrod, M. F., Some pharmacological
studies of aglutamic acid-lysine
copolymer.

Wetlaufer, D. B., Degradation and
reactivity of myosin in urea solu-
tions.

White, L. P., On the prevention of
toxicity of nitrogen mustard.

American Association for Cancer Re-
search — April I960.

DAngio, G. J., and Brown, B., Potenti-
ation of x-ray effects on normal
mouse skin by actinomycin D.

Foley, G E., Friedman, O. M., and
Drolet, B. P., Studies on the
mechanism of action by Cytoxan, I.,
Evidence of activation in vivo.

Handler, A. H, and Cohen, J., A trans-
plantable ascites sarcoma in the
Syrian hamster.

Kato, R., Yerganian, G, Grodzins,
L. A., and Stewart, S., Sex chromo-
somes and transplantability (in vivo)
of polyoma-induced sarcomas in the
Chinese hamster.

Kim, U., and Furth, J., Role of mam-
motropic hormone in induction and
growth of mammary tumors by 3-
methylcholanthrene.

Maddock, C. L, Brown, B., and

D'Angio, G J., Enhanced response
of Ridgway's osteogenic sarcoma to
x-irradiation combined with acti-
nomycin D.
Tsukada, H., Kaneko, A. I., Onoe, T.,
and Fu, S.-C. J., Comparative studies
on respiratory metabolism of sensi-
tive (4N) and nitromin-resistant
Ehrlich ascites tumor cells.
White, L. P., Anti-tumor activity of

non- toxic preparations of HN2.
American Association of Pathologists
and Bacteriologists — April I960.
Yerganian, G, Green, M. N., and
Meier, H., Spontaneous hereditary
diabetes mellitus in the Chinese
hamster: pathologic, biochemical,
and genetic findings.
Vlllth Congress, International Society
of Blood Transfusion — September
1960.

Djerassi, I., Farber, S., Evans, A., and
Yoshimura, H., Observations on
transfusions of fresh human platelet
concentrates.
Yoshimura, H, and Djerassi, I., Studies
on the hemorrhagic tendency in
heparin-treated animals.
Vlllth Congress, International Society
of Hematology — September I960.
Djerassi, I., Yoshimura, H., and Roy,
A., Effects of soybean phosphatides
on bleeding in thrombocytopenic
rats and dogs.
Roy, A., Yoshimura, H, and Djerassi,
I., Hemostatic effects of heterologous
platelets in thrombocytopenic rats.
Yoshimura, H, and Djerassi, I., Obser-
vations on oxygen uptake by human
platelets.
Tokyo Symposium on Cancer Chemo-
therapy — October I960.
Farber, S., Current clinical and experi-
mental studies in cancer chemo-
therapy.
American Chemical Society — Septem-
ber I960.

Fu, S.-C. J., "Nitrogen mustard" of the
folic acid side chain — N-bis (cbioro-

ethyl) -p -ami no benzoyl -glutamic
acid.

Chatter jee, S., DuBois, E. P., and
Modest, E. J., Synthesis of 4, 5-
pentamethylenepyrimidines as poten-
tial growth inhibitors.

Lemlein, S. A., Chatterjee, S., Foley,
G E., and Modest, E. J., Growth
inhibition studies with selected 6,
7-disubstituted pteridines.

Modest, E. J., Chatterjee, S., Lemlein,
S. A., and Brun, D. M., Synthesis
of certain 4-mercaptopyrimidine
derivatives.

113

DEPARTMENT OF OTOLARYNGOLOGY

DEPARTMENT OF
OTOLARYNGOLOGY

This is a brief report on the aaivities
of the Otolaryngology (Ear, Nose and
Throat) Service for I960. During
this year our patient load continued to
remain high on the in-patient service
insofar as admission and operations
were concerned. However, despite this
an economic and nursing problem was
created for the hospital since most of
these patients were in for throat op-
erations (tonsillectomy and adenoidec-
tomy) and remained in the hospital
for less than 30 hours. A word of ex-
planation for this situation might be
in order. A "T. & A." is an elective
operation performed on a well child
and in most instances requires very
little in the way of a hospital workup,
the patients having been previously
examined by at least two doctors be-
fore admission was decided upon. The
average age of these patients is about
*>Vl years. Admission to the hospital
occurs early on the morning of opera-
tion and the child is escorted to the
ward in company with one or both
parents who remain with the patient
until he or she is removed to the op-
erating room under sedation, usually
asleep. Except in most unusual cir-
cumstances the patient is well enough
to be discharged home the following
day. This method of handling chil-
dren for T. & A. has been used here
for the past 25 years and may be said
to have stood the test of time. It has
several points, unrelated to cost, which
appeal strongly to parents. Among
these may be mentioned that admission
occurs at a stated time on the day of
operation, the parents are encouraged
to stay with the child until removal to
the operating room, while on the ward
they meet the nurses and doctors who
give postoperative care and see the
kindly and efficient manner in which
the children are treated. As a result
many parents express their apprecia-
tion directly or by letter for the high

quality of care received, while com-
plaints are few and far between. It is
hoped that some solution to the
economic and nursing problem can be
arrived at which will permit us to con-
tinue to handle these patients as we
do now.

Advances in middle ear surgery
during the past five years or so have
enabled us to salvage the hearing func-
tion and repair certain defects in this
area which previously could not be
helped at all, or which had to be
treated by obliterative procedures.
Many perforated eardrums can now
be closed, in certain patients, by the
use of vein grafts or very thin skin
grafts, usually with improvement in
hearing. In some patients with chronic
mastoid disease and destruction of the
eardrum, removal of the diseased
bone and other tissues followed by
skin grafting can result in a "dry" ear
and sometimes a substantial improve-
ment in hearing. Much of this work
has to be carried out while the surgeon
observes through an operating micro-
scope which magnifies from 6 to 40
diameters. Our microscope, donated
to us by the Women's Committee four
years ago, has been put to good use
and will undoubtedly be even more
widely used in the future as new tech-
niques are evolved.

Our affiliated Resident Training
Program with the Massachusetts Eye
and Ear Infirmary has worked out very
well over the past three years and
should continue to provide a period of
concentrated experience in children's
otolaryngology for the Eye and Ear
Residents in their third year of spe-
cialty training. Each resident spends
three months with us and is kept busy
with out-patient work, operating, staff
consultations, and other hospital ac-
tivities. The advantages to the hospi-
tal of staff coverage by a young man
with a training background of at least

114

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

two years in a specialty are too evi-
dent to need amplification. Continua-
tion of this relationship should be
encouraged in every way. Much of the
work of the resident is carried out in
the out-patient department and one of
our pressing needs is better out-patient
facilities so that more than one doctor
at a time has a place in which to ex-
amine patients. Some of our patients
have to wait two or three hours to be
seen. At the present time the out-
patient clinic is a one-man operation.

The Otolaryngology Department
exists as a separate unit with its own
operating suite and ward (Division
14) housed in Building A some dis-
tance from the other clinical services.
The ward and operating facilities are
used almost exclusively by this service
with the exception of an occasional
eye patient. While this physical setup
has obvious merits it also has serious
drawbacks not the least of which is
the expense of maintaining and staff-
ing the area, particularly the operating
suite. In future planning for the clini-
cal services serious thought should be
given to the integration of the Oto-
laryngology Department with the
other services dealing with the medi-
cal and surgical problems of children,
if any significant improvement in the
cost of this operation is to be attained.

HEARING AND SPEECH CLINIC

Under the direction of Adam J. Sor-
tini, Ed.D., this clinic has increased in
size and importance, year by year,
since 1952 when it was started with a
staff of one, to I960 when it had a
staff of fourteen and 10,766 patient
visits. Among other distinctions, it
has the highest patient load of any
clinic of its kind devoted to children
in the world (with the possible ex-
ception of Russia). An important
affiliated unit of this clinic, The Sarah
Fuller Foundation, is primarily con-

cerned with the teaching of pre-school
deaf children. At the present time this
unit has a staff of three teachers of the
deaf and a social worker in addition to
the part-time services of a psycholo-
gist. This group is currently engaged
in teaching 45 or more severely deaf-
ened pre-school children who are able
to hear, if at all, only with the help
of a powerful hearing aid. Patients
come to this clinic not only from New
England but from all over the United
States and Canada. We have also had
patients from as far away as Greece
and Iran for diagnostic study. Part of
the clinic is housed on the opposite
side of Longwood Avenue from the
hospital and part of it on the third
floor of the Administration Building.
In neither place are the facilities or
space adequate for the job we are
called upon to do and here again our
patients must wait, sometimes a mat-
ter of weeks, to be seen.

Carlyle G. Flake, M.D.
Otolaryngologist-in - Chief

115

DEPARTMENT OF DENTISTRY

DEPARTMENT OF
DENTISTRY

The activities of the Department of
Dentistry have continued to expand
and diversify since my last report. The
demand for clinical care of patients
who need the special facilities pro-
vided in our Hospital or who are the
responsibility of the Hospital con-
tinues at a high level. Thus we have
had an abundance of clinical teaching
material at all levels of training, but
time available to the permanent staff
for individual research efforts has been
less than optimum.

Despite the heavy patient load,
the Department has contributed sig-
nificantly to the teaching program at
the Harvard School of Dental Medi-
cine. In addition to being responsible
for the undergraduate teaching of
pedodontics and orthodontics at the
School, our permanent staff members
were sponsors for no less than four
undergraduate research projects this
year in a class of thirteen students.
One graduate student completed his
three-year postdoctoral fellowship in
June, I960, having received his clini-
cal training in orthodontics in our De-
partment. Two new students were
enrolled in September.

The Department, in addition to
giving numerous lectures and clinics,
figured prominently in the affairs of
the Massachusetts Dental Society this
past year. Three members of our staff
served as chairmen of the Educational
Program in January, and the pedodon-
tic and orthodontic sections of the
State meeting in May.

Having two interns in pedodon-
tics has strengthened the service and
their training appreciably. The house
officers find themselves less harassed
and have more time for study and
mutual exchange of ideas and clinical
experiences.

This summer a Panorex X-ray
unit was installed in our Department,
one of twenty-five such units available

in the country. This machine makes it
possible to produce an image of all the
teeth on a single film. We have ex-
plored the research possibilities of the
technique, and a report on its applica-
tion is in preparation. These X-rays
are particularly helpful for delineation
of gross lesions and have been of serv-
ice to many departments of the Hos-
pital.

A new accounting system has
been set up for the Department
through the cooperation of Mr. Held.
We are hopeful that the financial
status of the Department will show a
justification for a moderate increase
in salaries for non-professional per-
sonnel. At the present time we have
two positions open that we have been
unable to fill at the current wage scale.

In 1961, our research manpower
will be strengthened by a capable
young man whose knowledge of
salivary chemistry and nutrition is al-
ready well documented. He will di-
vide his time between the Hospital
and the Harvard School of Dental
Medicine, where he will also continue
his research with Dr. James H. Shaw,
Associate Professor of Biochemistry.

Although our quarters can no
longer be called strictly new, I con-
sider them new and am pleased to re-
port that they are and have been kept
in excellent condition by the Main-
tenance and Housekeeping Depart-
ments responsible.

Paul K. Losch, D.D.S.
Dentist-in-Chief

116

REPORTS OF CHIEFS OF THE MEDICAL SERVICES

OPHTHALMOLOGY
DEPARTMENT

The Ophthalmology Department has
continued to provide consultation
service to all units of The Children's
Hospital Medical Center, including the
Children's Cancer Research Founda-
tion, The House of the Good Samari-
tan, and the Children's Mission to
Children, etc. With Dr. Harry Shwach-
man's cooperation, the Department is
carrying out an ophthalmologic survey
of patients with cystic fibrosis. The
Department is also participating in a
study relating to congenital anomalies.
While no actual tally of the number of
consultations has been kept, they aver-
age about three per week, but vary
from none to seven per week. The
Department could probably function
more effectively if it were provided
with some sort of examining room,
were it ever so humble. We look for-
ward to the possibility of having a
Fellow in Ophthalmology in residence
and beyond this to the eventual re-
establishment of the Eye Clinic.

Trygve Gunderson, M.D.

Ophtbalmologist-in-Chiej

Bibliography

Gundersen, T., Cornea and sclera: in-
juries and diseases. In Traumatic
Medicine and Surgery for the At-
torney, VoL 4. Butterworth. (In
press.)

, Surgical treatment of bullous

keratopathy. Arch. Ophthalmol., 64:
260, I960.

and Liebman, S. D., Relation-

ship to systemic disease. In Sanders,
T. E. (Ed.), Pediatric Ophthalmol-
ogy. Mosby. (In press.)

117

REPORTS OF ADMINISTRATIVE DEPARTMENTS

The Changing Face of Administration 119

Nursing Service and School of Nursing 121

Social Service 127

Out-Patient 129

Medical Records 132

Patient Education and Recreation 134

Physical Therapy 13 5

Personnel 137

Volunteer Service 138

Dietary 139

Purchasing 140

Visual Education 141

Pharmacy 142

Special Services 143

Communications 143

Employee Health Service 144

Maintenance 145

Surgical Appliance Shop 146

Housekeeping 147

Print Shop 147

119

THE CHANGING FACE OF ADMINISTRATION

The administrative departments underwent the following changes
in 1960:

Mr. Greer Williams in March succeeded Mr. A. William Smith,
Director of Resources, but, as Assistant Director in charge of develop-
ment and public relations, Mr. Williams acquired the additional responsi-
bilities of supervising and coordinating the Departments of Fund Rais-
ing and Public Information.

Mr. Smith remained with the Hospital to spearhead the organi-
zation of the Cooperative Hospital Laundry, an enterprise which he
initiated to provide laundry services for at least five major hospitals.

Mrs. Harriet H. Gibney in June became Director of Public Infor-
mation, succeeding Mrs. Shirley Van Cleef, who resigned.

Mr. John Glancy in June became Director of the Surgical Brace
and Appliance Shop, succeeding Mr. Edward Roberts, who retired.

Mr. Richard E. Held became Comptroller in August, succeeding
Mr. Edward S. Lancaster, who retired.

Mr. Alexander T. Brown became Director of Personnel in October,
succeeding Miss Adeline Morrill, who retired.

Mr. George D. Nicoll, for ten years carpenter foreman, in October
became Director of an entirely new department, Special Services.

Miss Marion W. Hall, Director of Social Services, retired in October
after twenty years of service. Her final report appears elsewhere in
this document. She died on March 24, 1961.

121

REPORTS OF ADMINISTRATIVE DEPARTMENTS

NURSING SERVICE AND
SCHOOL OF NURSING

NURSING SERVICE

There are features of hospital nursing
services which are not common to all
enterprises and which make for diffi-
culties in planning and operation.

One feature is that the nature and
extent of the task to be done is un-
predictable and never under the con-
trol of those charged with the respon-
sibility to carry it out. Another is that
the task must be carried on seven days
a week, twenty-four hours a day. These
facts are so obvious that they tend to
be taken for granted, yet they under-
lie the gravest problems with which
the nursing department must attempt
to cope. That these characteristics are
not unique to nursing is also true, for
other departments face the same prob-
lems though in a lesser degree.

Unpredictability stems not only
from the emergency nature of much
hospital work but also results from
other causes not as readily apparent.
For example, patient population rises
and falls as illness in the community
increases or declines; it is likely to be
low during the holiday periods and
high in the early summer when much
elective surgery is to be done. Some
of these can be anticipated with a cer-
tain assurance although patterns
change from year to year. More irreg-
ular are the individual plans of mem-
bers of the medical staff; a week-long
meeting of surgeons or pediatricians
may alter the work load markedly as
also may the fact that a large number
of physicians take their vacations at
the same time.

As a consequence the work load
is unevenly distributed with quite a
considerable range between the low
and the high. In 1959-60 for example
the monthly average of patients showed
a low of 230 in December and Sep-
tember and a high of 285 in June, or
an increase of fifty-five patients on
the average in the latter month, almost

25 per cent more than in the other
two. Similarly operations ranged from
398 in September to 577 in June, an
increase of nearly 45 per cent.

Such deviations pose a crucial
question: does one attempt to staff for
the peaks or try to strike an average?
The problem remains even if a group
of temporary workers could be drawn
upon to meet a sudden need. This is
unlikely to be the case at any time
for most nurses who work desire regu-
lar employment; others who might be
available as temporary auxiliary work-
ers require too much training to be
useful on a short term basis.

An unfortunate aspect of these
variations, even when they can be
anticipated, is the inability of the
nursing service to relate work load to
availability of staff. For example,
peaks in June or July are extraordinar-
ily difficult to meet since many nurses
leave the staff in the early summer
and vacations must be given during
this time. Thus there are likely to be
periods when nursing cannot provide
enough care for patients, employees
work overtime and many frustrations
develop.

It is probable that there is no
complete remedy for the situation
since so many different factors and
people are involved: it is possible
however that joint planning and more
exchange of information might miti-
gate some of the worst aspects.

The twenty-four-hour nature of
the job presents the nursing staff with
other serious problems. In these days
of plentiful employment opportunities
it is most difficult to find persons who
are willing to work weekends and
nights. These periods are not popular
with any but a small proportion of
the population; they are intensely dis-
liked by most young women, the group
upon which nursing services must
rely for the most part. Intense pres-

122

REPORTS OF ADMINISTRATIVE DEPARTMENTS

sure upon employees to work at these
times tends to result in absenteeism
or even withdrawal from the job.
While resistance to working at these
hours has been increasing, the need
for staff at such times has mounted
rapidly. More emergency and late ad-
missions, more work done by residents
during the evening hours, a higher
proportion of critically ill patients and
a decline in availability of student
nurses have all combined to produce
this need.

While nursing service does not
control the scope of the task which it
must do, it has the added problem of
being dependent to a great extent
upon supporting services from other
departments, departments over which
it has (and should have) no jurisdic-
tion. In too many instances nursing
is responsible for work which might
better be done by these departments
or is obliged during night and week-
end hours to take on jobs which are
done elsewhere during weekdays. This
may be because the work load is too
small to warrant twenty-four-hour
coverage in the other department or
it may result from another depart-
ment's difficulty in obtaining staff at
these awkward times. Whatever the
reason, the result often is added work
for nursing service which must always
be at hand to meet its commitment
as best it may. Examples of this pe-
culiar situation, both in this hospital
and in others, are too obvious and
frequent to need to be cited.

Lest these comments be inter-
preted as indicating a wish to unload
work onto other hospital departments
perhaps a word of explanation is in
order. There is an historical back-
ground for the situation which per-
sists to some extent in this institution
today and was common to all hospitals
until recently.

Because nursing at one time was

responsible for many of the activities
now allocated to dietary, housekeep-
ing, laundry, etc., it had a difficult
time to get transferred to these new
departments many of the responsibili-
ties which are appropriate to them.
And because nursing was always here
at night, it was never able to relin-
quish some tasks which properly are
not nursing at all.

Aside from the fact that much
of the work referred to is more ap-
propriate to another department, it is
also obvious that it is costly to use
the time of registered nurses to do
jobs for which little training is re-
quired and which can be done in
many instances by a person whose
wages are less. Fortunately many
gains have been made in regard to
this problem; doubtless more will be
as time goes on.

In recent years change appears
to be the only constant in hospitals;
change affects nursing in a number
of ways. One of these is the develop-
ment of new methods of treatment
which require new learning for the
nurse; as the physician introduces new
therapies, he sometimes turns over to
the nurse responsibilities which he
formerly assumed. A good example is
the administration of medication by
the intravenous route, a procedure
formerly done by the residents, now
the responsibility of the graduate
nurses. This change alone, adopted in
1959, has created a need for more
nurses as the increasing use of the
method consumes many hours of their
time each day.

Another change, evident in the
past decade in particular, is the short
stay of most patients. This trend, so
advantageous to the patients, has posed
considerable problems for the hospital
and affects many departments. In
nursing it has a tendency to make
management of the division more

complicated for paper work multiplies
and supervision of patient care is dif-
ficult when there are so many new
children each day. Doubtless it con-
tributes, too, to the nurse's lack of
satisfaction in her job as she becomes
less acquainted with her patients and
less able to feel joy and pride in the
piogress of children well known to
her.

Finally, changes in personnel
make stabilization of the service ex-
ceedingly difficult; orientation and
training programs help but they can-
not entirely substitute for longer em-
ployment and the familiarity with de-
partmental needs which comes from
experience. The operating room pro-
vides an excellent example; there it
has been accepted that the first six
months of a nurse's employment is
largely orientation; if she leaves at
the end of the first year the productive
period is very brief.

Changes in staff have been a
serious problem during the year as
they have been in the past. Figures
which show a high rate of turnover
quite properly give rise to concern,
yet such figures can be most mislead-
ing if not examined with care.

During the past year ninety-five
graduate nurses were newly employed
and ninety-seven terminated; these
numbers represent more than half the
total number of such persons usually
employed.

Analysis of the ninety-seven
shows the following, however: four-
teen persons came for specified tem-
porary employment; twelve were
foreign nurses under the exchange
visitor program in which the usual
plan is for a six-month experience.
If these are excluded from the total
we find that the turnover figure is 48
per cent, still high but slightly lower
than in 1958-59. Moreover, of the
entire group we find that approxi-

123

REPORTS OF ADMINISTRATIVE DEPARTMENTS

mately two-thirds left because of com-
pelling personal circumstances. The
balance is twenty-two persons, or 31
per cent of the total who left this in-
stitution, who went to other positions.
Three of these had been employed
less than a year; the average length
of stay for the twenty-two was two
years; six had been here for three or
more years.

If these twenty-two registered
nurses who left the staff for unknown
reasons, perhaps including dissatisfac-
tion, represent the true turnover then
the percentage is 12.4 per cent — con-
siderably lower than that given above.
Yet this analysis affords little com-
fort for it becomes clear that relatively
little can be done to alter the rapid
change in staff; more effective ways
to carry on nursing service under such
conditions should be the primary ob-
jective.

Turning to the other groups in
nursing service, the aides, orderlies
and clerks, one finds a different picture
and one in need of vigorous methods
to bring about improvement.

Here we find that well over 100
persons came and went during 1959-
60. Approximately one-fifth were
summer employees but exclusive of
this temporary group the turnover
figures are as follows: aides, 77 per
cent; orderlies 100 per cent; clerks
138 per cent. These are much higher
than for the previous year, in some
cases nearly double, and unquestion-
ably reflect job dissatisfaction.

Figures do not show to what ex-
tent personal reasons contributed to
termination but in many instances
this doubtless was a factor. Yet it
appears probable that the chief ele-
ment has been the wage scale which,
until the new rates became effective
October 1, I960, had not been in-
creased since the spring of 1957. Un-
til the new scale has been in effect

for a few months it will be difficult
to determine whether or not other fac-
tors also play a large part in this dis-
tressing state of affairs.

Terminal interviews conducted by
the personnel department might be
helpful in such an analysis. It is im-
perative that this situation be im-
proved if nursing service is to ap-
proach a satisfactory equilibrium and
the expense of turnover to be reduced.
Unfortunately it is not known what
the actual cost of hiring and training
a new employee may be; it is known
that industry considers high turnover
a dangerously expensive matter.

The auxiliary worker is of im-
portance to nursing service as she
should assume duties for which she
is prepared and thus assist the regis-
tered nurses who always are in short
supply. Moreover, as educational pro-
grams for student nurses increasingly
reduce the students' availability, the
auxiliary workers become essential to
fill part of the gap.

Another group, the licensed prac-
tical nurses, is playing an increasingly
important role in patient care; it is
pleasant to report that we employed
last year more of these nurses than at
any time in the past. While the num-
ber remains relatively small and is less
than half that felt to be needed, there
is now reasonable hope that the de-
sired number may eventually be se-
cured.

Efforts at reorganization of the
service, begun several years ago, in
order to involve more members in the
work of the entire department and
in improvement of patient care as
well as to bring groups with common
interests together to study and attempt
to solve their problems, have begun to
bear fruit. Committees working on
procedures, records and educational
and training programs have been ac-
tive and productive. Unfortunately

committee work takes time but it is
only through such groups that much
of the work of a large and diversified
department can be accomplished.

Mrs. Marion Stewart joined the
education department of the nursing
service as instructor of auxiliary work-
ers. For much of the year she was
obliged to supervise the House of the
Good Samaritan but with the appoint-
ment during the summer of Miss Mar-
garet Francis as supervisor on the
convalescent divisions and the res-
pirator unit, Mrs. Stewart was freed
to give more time to her task of train-
ing and will in the coming year be
able to develop this program better to
meet current needs.

All the changes in personnel men-
tioned earlier place a great responsi-
bility on the education department.
There are three persons at present; a
fourth has been requested for the com-
ing year to have as her principal re-
sponsibility the instruction of nurses
in the care of patients having cardio-
vascular surgery.

In addition to a continuing pro-
gram of instruction this department
assumes responsibility for early orien-
tation of new staff members and ar-
rangements for the many visitors who
come to the hospital. The number of
new nurses employed in I960 gives
an indication of the size of the task;
visitors too continue to increase in
number so that last year the depart-
ment made plans for and met with
seventy-two persons or groups.

Miss Francis, now supervisor in
the House of the Good Samaritan,
previously was assistant to the ortho-
pedic supervisor, Miss Gassman, and
thus comes to the new position pos-
sessing a familiarity with the respi-
rator unit which is exceedingly helpful.

Miss Jeanne Colt, surgical super-
visor, was on leave of absence for
study throughout the year, returning

124

REPORTS OF ADMINISTRATIVE DEPARTMENTS

early in September. Mrs. Ann Lenni-
han came from the Out-Patient De-
partment to assume Miss Colt's super-
visory duties temporarily. She has now-
returned to the Out-Patient Depart-
ment as assistant supervisor.

During the summer of I960, staff
vacancies necessitated the closing of
the Medical Emergency Clinic during
the evenings. Until the fall of 1958
one emergency clinic, surgical, had
cared for all patients during evening
hours. In that year the second clinic
was opened because of the increase
in emergency visits which totaled
about 700 between 1957 and 1958.
Between 1958 and I960 a phenome-
nal rise of 5,700 in such visits occurred,
most of them in the evening hours,
hence the closure of one evening
clinic caused a serious situation.

Not many years ago the nature
of the emergency service was such
that nurses with relatively little ex-
perience in the department would
meet the situation if necessary; today
this is no longer true and the nurses
who assume this responsibility must
have a considerable period of indoc-
trination. When a number of persons
left the staff during the summer there
were not enough qualified persons
available for these hours.

Staffing the two clinics is costly
for the hospital but with the present
physical arrangements no other solu-
tion is possible. With sufficient space
suitably planned to meet the needs
of all emergency patients one clinic
should meet the need effectively and
at less cost.

The operating room is another
department in which experience of
staff is of the greatest importance;
v/hen vacancies occur the replacement
must often be by a nurse without suf-
ficient experience to permit her to
carry a full share of responsibility.
Resignations in the spring, therefore,

presage difficulty in the ensuing
months when work load is high and
staff must have vacation.

The number of operations in I960
exceeded slightly the total for recent
years; the total is, however, of less sig-
nificance than the nature of the sur-
gery and the fluctuations in work load
from month to month or even from
day to day.

Day-to-day planning has been im-
proved this past year by an arrange-
ment which gives the supervisor more
responsibility for scheduling opera-
tions and by cooperation between the
Admitting Department and the Op-
erating Room in the bookings.

The additional space alloted to
Central Supply this year, as a conse-
quence of the closing of the old Blood
Bank, has been of great value. It will
not be used to the best advantage,
however, until certain structural
changes have been made; the plan for
these is dependent to some extent
upon the decision to be made regard-
ing purchase of solutions for intra-
venous therapy.

The hospital has been fortunate
to have had senior supervisors on the
evening and night service who have
held those positions for a long time.
Not only are the hours difficult ones
but the responsibilities which these
persons must assume are onerous so
that suitable nurses are not easy to
find. The less experienced assistant
supervisors have changed more fre-
quently; this year a number of appoint-
ments were made: Mrs. Ann Hoist
Clark became assistant evening super-
visor; Miss Jacqueline Patterson was
appointed night assistant supervisor;
Miss Joan Bodman, formerly employed
as an assistant head nurse, returned to
the evening service.

It is not possible to mention in-
dividually the many persons whose
services to the hospital were termi-

nated, nor the many new appoint-
ments which have been made. The
many devoted persons who have been
unstinting in their efforts to give good
care to children, all deserve high
praise.

The department has been involved
in two new projects this year, both
interesting and both time-consuming.
The first is a study of the cost of run-
ning the School of Nursing, a study
which is part of a nation-wide project
of the National League for Nursing.
This is of course primarily a school
undertaking but all head nurses and
supervisors in departments to which
students are assigned have had a part
as well. Secondly, the new cost ac-
counting system and the new methods
of budgeting instituted at the begin-
ning of the year have taken time of
members of the supervisory and ad-
ministrative staff. The knowledge
gained from this experience, however,
has been of value in developing in-
creasing awareness of the expense of
each unit.

The department has reason to be
grateful to the Volunteer Department
for the help rendered, especially dur-
ing the day in transportation of pa-
tients. Evening volunteers, while less
numerous than last year, have given
about 2,000 hours to the care of pa-
tients.

Attached to this report is a sum-
mary of the number of employees
requested for the department in the
1961 budget.

AUTHORIZED POSITIONS

Budget Requests 1961

PROFESSIONAL NURSES

Director

Associate Director

Assistant Directors

Supervisors

Asst. Supervisors

Head Nurses

125

REPORTS OF ADMINISTRATIVE DEPARTMENTS

Assr. Head Nurses 21

Staff Nurses 137

Director, Education 1

Instructors 2Vi 210

LICENSED PRACTICAL NURSES 49
AUXILIARY WORKERS

Aides 93 Vi

Orderlies 15Vi

Div. Clerks 18Vi
Ward Manager 2 129^2

SECRETARIAL AND CLERICAL

Secretaries 2

Clerk-typist 3
Clerk Vi 5Vi

Total ~~ 394

SCHOOL OF NURSING
In September a new class of forty-five
students of nursing entered the school;
of these thirty-three live in Massachu-
sets, nine come from the other New
England states, and one each from New
Jersey, North Carolina and Ohio.

The Admissions Committee con-
tinues to select the class from approxi-
mately 200 applications, of which
some are from individuals who have
applied to more than one school and
may not have this as the first choice.
Last year the committee reviewed 187
records; approximately the same num-
ber of individuals were interviewed
and taken around the hospital and
Gardner House.

The institution of an application
fee in 1959 seems not to have altered
significantly the number of applica-
tions filed, except to reduce the num-
ber received from persons not serious
about entering the school; the num-
ber of incomplete applications
dropped from about sixty in 1958 to
sixteen in I960. Since the processing
of applications is a time-consuming
and costly task, this reduction is most
welcome.

The committee has been accept-

ing approximately three students for
each two who enter the school; in
other words, one in three changes her
plans after filing application.

At the close of the year I960,
the school of nursing was smaller than
at the same time last year due to a
higher withdrawal rate than is usual.
Most of the students left because they
were not successful in passing the
courses in the first year.

There were thirty- two members
in the graduating class, for whom ex-
ercises were held at the Temple Israel
on September 18. The speaker on this
occasion was Dr. Ernest Caverly, Su-
perintendent of Schools in Brookline.

Fourteen of the thirty-two joined
the staff at the hospital, a somewhat
lower number than in most years. At
least seven of the graduates had plans
to marry and to live elsewhere than
in Boston.

Two members of The Children's
Hospital faculty are on leave of ab-
sence this year for study. One of these
is the instructor in orthopedic nursing,
Miss Ann Noon, whom it has not been
possible to replace; the other, Miss
Margaret Heafey, is away for one
semester. The vacancy created by the
resignation of the instructor in public
health nursing in June has not as yet
been filled. Miss Phyllis Diegoli, in-
structor in surgical nursing, left the
staff in order to do graduate study.

The following faculty members
have been appointed: Miss Jean
Crocker, The Children's Hospital
School of Nursing, teaching assistant;
Miss Carmel DiNicolantonio, St. Eliza-
beth's Hospital School of Nursing,
Youngstown, Ohio, and B.S., St. Louis
University, instructor in surgical nurs-
ing ; Miss Joan Grindley, Catherine
Laboure School of Nursing and B.S.,
Boston College School of Nursing,
junior instructor in fundamentals of
nursing.

At the annual meeting in 1959 the
Women's Committee voted to give ap-
proximately $1,200.00 for the Scholar-
ship Fund, thus increasing that fund to
a total of $5,333.20 The Alumnae As-
sociation of the School of Nursing
also contributes a sizable sum each
year for scholarships.

During the past year eleven
scholarships have been awarded; these
usually are for $100.00.

The Alumnae Association also
sent a student to the National Conven-
tion of the Student Nurses' Associa-
tion in the spring of I960.

Following the reorganization of
the Medical Center and the adoption
of the new name, there was discussion
in the Faculty and in the School of
Nursing Committee about the name of
the school. Thus far no change has
been made, and the school continues
under its old title until a decision is
reached by the Board of Trustees.

Affiliate Program

There have been faculty changes
in the affiliate program. Miss Amy
Nurse, the chairman, resigned at the
close of the year because of illness.
No appointment has been made of a
new chairman. Miss Diana Misenti,
one of the instructors in the program,
is on leave of absence during 1960-61
for study. Mrs. Margaret Crooker and
Miss Patricia Walsh also left the staff
during the year.

Three new appointments have
been made to this program: Miss Rita
Bryant, Boston City Hospital School
of Nursing and M.S., Boston College;
Miss Nancy Parker, The Children's
Hospital School of Nursing and B.S.,
Boston University, and Miss Helene
Marsh, B.S., Boston College School of
Nursing.

There are nineteen affiliated
schools, all but two of which send stu-
dents throughout the year. The school

126

REPORTS OF ADMINISTRATIVE DEPARTMENTS

was notified in the spring that the
Roger Williams General Hospital
School of Nursing in Providence,
Rhode Island, wished to terminate the
affiliation in Ocotober because it was
ready to present a program in pedi-
atric nursing in the home school.

This withdrawal of a school of
moderate size reduces slightly the
number of students entering here but
it is rather unlikely that an application
from another school will be accepted
immediately since the number of stu-
dents in the last several years has
seemed to be larger than desirable in
relation to the facilities, housing and
available faculty.

In 1959-60 the total number of
students entering the program was
587. Plans for 1960-61 are for 522
students.

In the fall of 1961, the total num-
ber of days of evening and night duty
will be reduced five per student in the
twelve-week period. Also contem-
plated in the near future is a change
in instruction in formula preparation.
The Approving Authority for Schools
of Nursing has given tentative ap-
proval to a plan which will eliminate
the present requirement that students
spend two days preparing formulas
for infants. Other instruction and ex-
perience will be substituted.

College Program

Miss Leona Stapleton, one of the in-
structors in the program for these stu-
dents, transferred to the nursing serv-
ice as a head nurse early in I960. She
was replaced by Miss Marie Cullinane,
a graduate of Boston College School
of Nursing, and M.S., Catholic Uni-
versity in Washington.

During the year seventy-seven
students have come from the colleges
to complete the twelve-week experi-
ence.

Miss Mary Young, the librarian,

resigned in the early summer; fortu-
nately, it was possible to appoint in
her place Miss Jutta Luhde, a gradu-
ate of the Simmons College School of
Library Science. Miss Luhde is the
first full-time librarian the school has
had.

In recent years the acute housing
situation has been reported upon fre-
quently; at times it was feared that the
school would not be able to accommo-
date all the students for whom ar-
rangements had been made. During
this year there has been an easing of
this situation with an average of 208
in residence. It is hoped that at some
date not too far distance the two floors
at 329 Longwood Avenue now oc-
cupied by students may be reclaimed
for staff housing. The arrangement at
329 is not a satisfactory one since rela-
tively few individuals are housed,
most rooms are not single and the cost
of maintaining a residence of this type
is excessive.

This year the school has become
involved in a study of the cost of nurs-
ing education which should provide
very helpful information for the school
and the hospital. The rising cost of
education is of concern in all fields be-
cause of the difficulty in finding funds.
Hospital nursing schools are in a par-
ticularly difficult situation since in-
crease in cost of running the school is
eventually reflected in charges to pa-
tients. It is, therefore, cause for satis-
faction that we may hope eventually
to have some accurate figures which
may be compared with similar studies
done in as many as 200 schools of
nursing throughout the country. This
is a project of the National League for
Nursing.

The school has cause to be grate-
ful to its many good friends, among
whom should be mentioned the
Women's Committee, the Alumnae
Association of the School of Nursing,

the members of the School of Nursing
Committee and the many doctors and
staff members who contribute to in-
struction of students.

Murial B. Vesey, R.N.

Director of Nursing Service

and School of Nursing

127

REPORTS OF ADMINISTRATIVE DEPARTMENTS

SOCIAL SERVICE

Introduction

When a report is written yearly, the
fear of repetition and staleness arises.
This fear has been unfounded during
the last decade or more of the tran-
sitional years when the hospital has
been growing and becoming unified
into a Medical Center. There are al-
ways new developments to present.
Mention should be made this year of
two in particular.

First, this Social Service Depart-
ment and the Children's Mission have
become closer in their staff relation-
ships and in unifying services to pa-
tients. This has been the result of a
joint effort on the part of both groups.
Case conferences and mutual explora-
tion of appropriate referrals were two
means which contributed to this end.

Secondly, the Social Service De-
partment has been assigned the ad-
ministration of several generous funds
which had been contributed for spe-
cial needs of individual patients. It
has, therefore, been possible to help
with such things as board and room
for desperate out-of-town families,
chair lifts for polio patients, and spe-
cial schooling.

Staff changes

The usual "hail and farewell's" have
been in evidence. In November, the
long- vacant position in Neurology was
filled by Miss Diane Livingston, who
had graduated the previous year from
Simmons College School of Social
Work and who had spent a year in a
Psychiatric Clinic in England. In
January, Mrs. Ann Sheingold resigned
from the Psychiatry Department to re-
turn to private life. She was replaced
by two half-time workers, Mrs. Fran-
ces Lewis and Mrs. Louise Lown, both
with previous experience. In June,
Mr. Andrew Johnston resigned from
the Respirator Unit to take a position
in a Rehabilitation Unit in Water-

ville, Maine. Also, Mrs. Nancy Norton
in Psychiatry resigned to accompany
her husband to the West Coast. At
the end of July, Mrs. Evelyn Silver-
man, who had been working a day and
a half in Psychiatry, retired to private
life. In August, Miss Suzanne Fleisch-
ner resigned from the Orthopedic
Service for advanced education in Pub-
lic Health. Miss Anne Turner from
the Simmons College School of So-
cial Work replaced her. Also, in
August, Mrs. Janet Mayer resigned
from the Medical In-Patient Service to
enter private life. She was replaced by
Mrs. Jane Scease who had just gradu-
ated from the Simmons College of
Social Work. In September, Mrs.
Virginia (Rugh) Wade resigned from
the Polio Service to accompany her
husband to Cleveland. She was re-
placed by Miss Mary Lou Weaver who
had just received her Master's Degree
from the University of Pittsburgh
School of Social Work. In September,
Mrs. Phyllis Haberstroh, a recent grad-
uate of Simmons College School of
Social Work with some previous ex-
perience in Canada, came to the Psy-
chiatric Clinic to replace Mrs. Norton.

Teaching

The course to student nurses was
again given in June by Mrs. Ruth
Cowin and the Director. Two students
were placed in Psychiatry, one from
Boston University School of Social
Work and one from Simmons College
School of Social Work, under the
supervision of Miss Walsh and Miss
Anderson. A third student was placed
in the Medical Division under the
supervision of Mrs. Ruth Cowin.

The Social Work Careers Pro-
gram again sent us a college student
for eight weeks during the summer,
supervised by Mrs. Evelyn Roll and
working primarily on the Orthopedic
Service. The Social Service Depart-

128

REPORTS OF ADMINISTRATIVE DEPARTMENTS

merit contributes its share of time to
giving lectures, being on panels, and
other community teaching.

Staff Education and Opportunities

Dr. Benaron continued his psychiatric
group consultation every other week
for the medical workers. A staff com-
mittee has been considering ways of
furthering staff education and stimula-
tion within the group. Attendance at
out-of-town conferences and further
formal education has been curtailed
by lack of funds, although the hospital
has been generous in allowing time.

Direct Service to Patients

The Social Service Department has
had major or minor interest in 4,606
patients during the year. Through our
camp program we sent 105 children
for 459 Vi weeks, carefully selected be-
cause their physical or emotional needs
seemed to warrant such an experience.

We have been increasingly con-
cerned with the number of children
coming to our attention either because
of demonstrated neglect or abuse, or
where such is suspected but difficult to
prove. We have worked closely with
the doctors and the Society for the
Prevention of Cruelty to Children on
these cases and are now collecting
them for study, to see if future han-
dling can be improved.

Of course, the Social Service De-
partment deals with many patients and
families and distances, including a
variety of foreign countries. Knowl-
edge of foreign languages, ways of
communicating with distant com-
munities, and arrangements for appro-
priate temporary living in Boston have
been additional facets to the ordinary
social problems. Facilities near the
hospital which will accommodate chil-
dren and allow cooking have become
increasingly more difficult to find.

Staff Needs

Request for additional members of the
Social Service staff assigned to the
Adolescent and Metabolic Units was
made by Dr. Gallagher and Dr. Crigler.
Lack of funds has prevented these
additions. Another psychiatric worker
has been requested this fall because of
the increased psychological and psy-
chiatric staff. A worker for the Surgi-
cal Service has been authorized, but
not yet found.

Adjustments and Hopes

With the relatively large staff of
twenty-eight members, widely dis-
tributed physically, working in some-
what self-contained units and in some
instances paid through special funds,
it is difficult to maintain integration,
cohesiveness and solidarity for the
whole department. Adjustment to the
continuous growth of the Social Serv-
ice Department has been a yearly
necessity since 1947 when the first
new social worker was added to the
Seizure Unit. This growth from seven
to the current number has made us
one of the largest departments in the
Boston hospital community. We are
now big and we feel it. Nevertheless,
the unity of the Social Service Depart-
ment has been maintained. The desire
and effort of each individual member
to be a part of the whole has been the
greatest welder, and has been the basis
of its esprit de corps during the last
year.

It is a pleasant custom at the end
of a report such as this to thank those
with whom we have been associated in
the year's work. At this time, I should
like to concentrate on expressing our
appreciation to Mr. Greer for his inter-
est in the department since his arrival,

and to Dr. Snedeker for the continued
interest and help he has given over
these many years.

Marion W. Hall*
Director of Social Service

*Miss Hall died on March 24, 1961.

129

REPORTS OF ADMINISTRATIVE DEPARTMENTS

OUT-PATIENT

The Out-Patient Department as a
whole has shown an increase within
the last five years in the number of
visits to the forty-one clinics that com-
prise this department. Attendance in
the three major clinics, however, has
remained the same and in some in-
stances a slight drop has been noted.
This drop is offset in the overall figure
by the increase in the Special Clinics
including the Medical Emergency.
Most of these clinics have reached
their optimum capacity and in some
instances have far exceeded their
physical facility.

In 1952 patients made 53,946
visits to the Out-Patient Department.
The following year the number jumped
to 70,802. The average number of
visits in the Out-Patient Department
for the last five years is between 85,000
and 87,000 per year. There have been
two exceptional years. The highest
figure recorded was in 1959: 97,667
visits were made to the Out-Patient
Department. The next greatest num-
ber was 91,478 visits in 1956.

In analyzing these figures, we find,
the Psychiatry Department showed an
increase in 1959 of about 5,000 visits
over the previous year. In 1957 they
moved to the east wing of "A" Build-
ing and in this area were able to meet
the need for a while. Presently the need
has again outgrown this facility. The
waiting list for appointment for treat-
ment is now from four to six months.

The Medical Emergency Clinic
has increased at a startling rate. It is
difficult to appreciate the "real" in-
crease here because in September,
1958, it was necessary to keep the
clinic opened until 1 1 P.M., seven days
a week, to accommodate the increase.
The statistics were thrown off balance
that year because the number seen
after 4:30 P.M. formerly had been in-
cluded in the Surgical Out-Patient
statistics.

The "real" increase may be
realized in the last two years, with the
hours and recording of statistics being
the same. In 1959, 12,234 patients
were treated. In I960, 14,216 patients
were treated. This increase has been
consistent for the last five years. Al-
though improvements have been made
such as supply cabinets and counters,
the problem of sufficient space has not
been solved. The space to maintain
adequate emergency and isolation
rooms as well as space for medical
students and clinical fellows is urgently
needed. Also provision for comfortable
waiting space for parents is lacking.

While the Medical Emergency
Clinic is showing a steady increase,
there appears to be a tendency for
lower clinic attendance in the General
Medical Clinic. The number of pa-
tients seen in 1958 was 6,595; in 1959,
6,694; in I960, 6,242. The number of
"new" patients has shown a decrease
also. In 1958 there were 2,761; in
1959, 2,755 and in I960, 2,405. The
waiting list for new appointments at
present is one week.

The following clinics have shown
an increase in patients treated:

1934 I960

Psychiatry 2,204 9,422

Division of

Child Health 1,751 3,089

Adolescent 4,393 5,766

Allergy 3,216 4,432

Cardiac 1,568 2,066

A number of alterations in ad-
ministrative procedure have been
made, aimed at increased efficiency,
reducing patient waiting, and increas-
ing the number of patients who can
be seen in the same time. These in-
clude the introduction of an advance
registration form to enable records to
be made out in advance for new pa-
tients so that they may be seen more
promptly in the morning and the use
of a preliminary history form which

130

REPORTS OF ADMINISTRATIVE DEPARTMENTS

parents may fill out while waiting.
This does not replace regular history
taking by the physician but provides
him with quicker answers to routine
questions such as those concerning
birth weight, siblings, immunizations,
etc. Efforts have been made to stream-
line the return of laboratory reports
and to have the reports obtained by
the clerks at the end of each afternoon
and put with the records of those pa-
tients scheduled to return the follow-
ing morning. This has been difficult
to do because of the difference in tim-
ing between the return visit and re-
turn of laboratory reports.

To facilitate the identification of
out-patients for charges an addresso-
graph identification plate system was
introduced in June, 1959. The plastic
plate when used properly identifies
the patients for billing primarily, but
may also be used in the internal op-
eration of the clinics. To date over
23,000 plates have been issued. The
great mobility of our patients makes it
necessary to re-issue plates not in-
frequently; this, combined with the
lag in establishing the plate system
throughout the entire out-patient de-
partment, leaves much to be desired
by the accounting department. In the
major clinics where the plate system
is well established there is evidence of
improvement in patient identification
and acceptance of the professional
staff of the plate as a time-saver in
making out requisitions and forms.

The Out-Patient Admitting De-
partment has been able to handle the
many details of admissions efficiently
and with consideration. The introduc-
tion of the addressograph plate system
and the "Rating" of parents according
to their ability to pay has of necessity
increased the number of personnel
needed in this department. The de-
partment is much too small both from
the standpoint of patient comfort and

personnel efficiency. Interviewing
should be conducted with some degree
of privacy. Remodeling with parti-
tions is unthinkable unless the area
can be air-conditioned. The need for
more room will not be solved until
this department can be relocated.

The increase in the clerical and
secretarial details of the clinics
throughout the Out-Patient Depart-
ment is noticeable. This has produced
in some instances better controls of
records, charges, appointments and has
improved patient satisfaction. Except
for the General Medical Clinic, an ef-
fort is made to type into the patient's
records the dictated clinic visit. This
is being done in many of the clinics
and allows the doctor more time to see
patients, thus cutting the waiting of
the patient to some extent.

The reading of former clinic
notes is no longer a problem and the
appearance of the record has im-
proved. In the Surgical Clinic over
135 clinic notes are typed each week.
The average in the Orthopedic Clinic
is 175 each week. In the General
Medical Clinic a letter is dictated and
sent to the referring doctor on each
new patient. An average of 250 let-
ters a month are mailed. The doctor
receives a letter explaining treatment,
diagnosis and disposition of his
patient.

An interdepartmental public ad-
dress system was established five years
ago in the Medical Out-Patient De-
partment between the nurses' station
and the clinic examining areas. This
has proved a great time-saver in sum-
moning the various doctors to the
telephone when they have calls.

Each clinic worked out a system
of "Processing Cards" which enables
them to have a record of the patient's
visit, his return appointment, and the
disposition of his medical record.

The Admitting Office felt the

need for revision of the addressograph
plate system which had not been en-
tirely satisfactory since its establish-
ment. In 1955 this was accomplished.
A two plate system was introduced.
It is now possible to send more de-
tailed information to areas that need
it, such as the Accounting Depart-
ment, by imprinting a three-by-five-
inch card with the nine-line plate, and
limited information to other areas by
the use of the four-line plate. This
plate is sent to the divisions with the
patient on admission.

In an effort to improve the ad-
mitting procedure and reduce the wait-
ing time for parents the admission
forms were studied. A multi-inter-
leafed form was finally accepted. This
eliminates the repetitive typing of
numerous sheets that make up the ad-
mission record. The Out-Patient ad-
mitting form was revised at this time,
thus making both house and out-
patient forms identical.

Conclusion. Although much has been
accomplished within the last five years
there is still a great deal more to do.
The entire Out-Patient Department
needs to be coordinated with more
centralized control which would tend
to eliminate the waste of time and ef-
fort expended caused by the lack of
knowledge or understanding of ad-
ministrative policies.

To improve medical care of the
ambulatory patient, I recommend more
regular Staff doctors be assigned to the
clinics responsible for the follow-up
of the patient. Follow-up by the same
doctor is not always possible when the
house staff doctor, because of other
commitments, is not in the clinic when
the patient returns.

I recommend one emergency
clinic with space adequate for this pur-
pose and all emergencies treated there
day and night. The Surgical Clinic

131

REPORTS OF ADMINISTRATIVE DEPARTMENTS

should be reserved for return visits of
these Surgical patients and all others
referred to it.

I recommend improvement in
methods of rating, coding, budget in-
terviewing, and charges.

The above summary has indeed
tended to emphasize the managerial
aspects of the department, with little
mention of the medical aspects. This
has been intentional, it being realized
that medical care, teaching, research
and staffing have been covered in re-
ports from the medical staff.

The accompanying list shows in-
novations, revisions and improvements
introduced into the major clinics and
Admitting Office within the last five
years.

Dorothy Pratt, R. N.

Supervisor,

Out-Patient Department

O.P.D. Admitting

Revision of the Multiple Admission

Forms, with reduction in cost of

form.
Both House and O.P.D. admission

sheets now are identical.
Introduction of the Addressograph

System of plastic plates for patient

identification.
Revision and improvement of the

method for handling the following:

Correspondence

Appointments

Follow-up on new patients who fail
to keep appointments

Follow-up on B.L.I. referrals.
Monthly review of M.O.P.D. schedule

with the Resident to coordinate the

patient load to the number of doc-
tors in the clinic.
Improvement of equipment and physi-
cal set-up:

Electric typewriters replacing man-
ual typewriters

New desks and chairs

Ventilator fan

Improvement of traffic flow

Pre-Registration Forms.
Revision of "Parent's Handbook."

S.O.P.D.

Addition of full-time secretary.

Extension of clerical coverage to 11
P.M. daily plus Sunday and holiday
coverage.

Dictation of clinic notes.

Improvement in correspondence con-
trol.

Renovation of the three Operating
Room tables.

New chairs and tables for the Examin-
ing Rooms.

Installation of air conditioning in Op-
erating Rooms No. 2 and No. 3, and
vent fan in Operating Room No. 1.

Remodeling of Utility Room.

Improvement in details of clerical job.

Establishment of a Day Sheet.

Improvement in method of compiling
accident statistics.

Individual Dressing Kits.

Purchase of additional instruments to
allow for the preparation of emer-
gency dressing trays and minor sur-
gical kits by Central Supply Room.

Blueprints for further remodeling of
the department.

Admitting Office

Extension of hours to 11:00 P.M.
daily, Sundays and holidays.

Introduction of a two-plate system of
addressographing, with marked im-
provement in the imprint.

Introduction of a Multiple Copy Ad-
mitting Form, and a Day Sheet with
a single appointment sheet to re-
place four books.

A survey of telephone calls. (Reduc-
tion of calls through wider distri-
bution of information on admis-
sions: three-by-five-inch imprinted
card sent to all residents and physi-
cians in C.H.M.C.)

A twenty-four-hour advance notice of
discharge.

Revision of "Notice of Discharge."

Revision of method and format of
daily Admission and Discharge List.

Typing and processing of Daily Cen-
sus Summary ( formerly done by the
Nursing Office).

Electric typewriters to replace manual
typewriters.

Purchase of an electric Addressograph
Machine to replace the manual im-
printer and relocation of equipment.

Removal of the Telefax Machine to
the Information Desk; removal of
Graphotype Machine.

Revision of "Parent's Handbook."

Updating of "List of Hotel Accom-
modations for Parents."

Free distribution of "Johnny Goes to
the Hospital." (Continued)

132

REPORTS OF ADMINISTRATIVE DEPARTMENTS

MEDICAL RECORDS

Medical

Control center remodeled. Laboratory
moved and remodeled. Secretary's
office established adjacent to Con-
trol Center. New floor covering
throughout.

Improved method of records control.

Creation of a dictating station, with
two dictating machines.

Introduction of a monthly report of
letters not dictated.

Inter-Department P.A. System.

Orthopedic

Revision of appointment book.
Improved method of filing Brace and

Processing cards and billing.
Addition of a secretary to the staff.
Dictation of all clinic visit notes.
Plaster Room painted and re-arranged.

Medical Emergency Clinic

Extension of clinic hours to 11 P.M.
daily, Sundays and holidays.

Addition of one staff nurse and one
nurse's aide.

Relocation of evening admitting clerk
in relation to the clinic.

Remodeling of department with im-
provement of facilities. Location of
Poisin Information Office in this
department to allow proximity to
the medical doctor who covers this
service.

Addition of two telephones with the
P.U. and H. System.

Air conditioning of the Isolation
Room. Vent fan on ventilation sys-
tem installed.

The attached statistical report clearly
indicates the trend of activity in the
Medical Records Department. It is one
of continuous increase in the volume
of records furnished for all uses. This
increase has added to the recognized
problem of operating in inadequate
space.

The completion of the first step
of microfilming, with a total of
171,500 records filmed and filed, al-
leviated a portion of the storage prob-
lem. The microtape system was placed
in use in January. It was interesting
to note that, after completion, the en-
tire cost of the system projected to the
total number of records resulted in the
surprisingly low figure of approxi-
mately 23 cents per record. This in-
cluded preparation of records, filming
and microtape reproduction set-up,
cards, indexing, folders, card cabinets,
reading equipment and storage of
negative film. There was a ratio of
better than 8 to 1 of cubic feet saved
between the space utilized by the cabi-
nets storing the records and those now
storing the microtaped cards with
room for expansion. This alone repre-
sents a saving in actual cash in operat-
ing cost, based on the hospital's own
evaluation of $10,343.00 per year.
The elimination of replacement of
cabinets, labor and moving, transporta-
tion, and time saved, results in an
additional saving of approximately
$3,500.00 to $5,000.00 per year.

The filming of the first group of
records provided for retention of
twenty years of active records in their
original form. A planned program
provided for retirement of one year of
records every year. Subsequently, the
1939 records were filmed and are now
in file ready for use.

There is a difference of approxi-
mately 6,000 records per year between
the rate of the early years and the pres-
ent rate of new records issued. There-

133

REPORTS OF ADMINISTRATIVE DEPARTMENTS

fore, even though one year of records
is retired each year, a balance remains
between those filmed and new records
issued, so that the filming program at
present does not solve the storage
problem.

In an effort to help with this
problem, additional space was pro-
vided in the basement of the Nurses
Home of the Good Samaritan. Open
shelves were installed, and records al-
ready stored there and those from the
basement of the Main Department
were moved to the shelves. A total of
131,900 records were involved in this
change-over, which was completed
September 30. An additional 13,025
records were shifted to the Annex of
the Main Department. In these moves
all records were checked and expan-
sion provided. A total of 244 misfiles
were found.

The basement of the Main De-
partment is in the process of renova-
tion, and upon its completion a total
of 126,375 records in the upstairs area
will be re-allocated, so that new shelf
space will be available for expansion.
This move will provide a maximum of
three to four years' space at the pres-
ent rate of new records issued.

During the renovation, the old
patient's index and diagnostic cards
were filmed. A total of 273,000 cards
are now in file on reel film. This pro-
gram provided for preservation of
data and release of space.

With new personnel in all sec-
tions, progress has been retarded be-
cause of necessary training. However,
the Correspondence Section is work-
ing on a current basis; the Secretarial
Section is holding the line on tran-
scription; and the Coding Section is
slowly making a gain in the backlog.
In spite of many handicaps, the Filing
Section has provided continuous good
service in an ever-increasing volume.

In August The Children's Hospi-

tal was approved by The Education
Committee of The American Associa-
tion of Medical Record Librarians as
an affiliated hospital for The Medical
Librarian School at Massachusetts Gen-
eral Hospital. A student will be as-
signed here to spend the month of
April on an internship basis.

Plans are in process to start a
training program for medical secre-
taries and coding clerks.

A paper entitled "Microfilm
Helps a Medical Record Department

Dig Out From Under," written by the
Director, was published in the Octo-
ber I960 issue of the magazine Micro-
filming and Data Processing.

The Medical Records Department
is appreciative of the cooperation, en-
couragement, confidence and assistance
of the Administration and of all the
Departments of the hospital during the
past year.

Marie Smith, R.R.L.,

Director,

Medical Records Department

STATISTICAL REPORT OF MEDICAL RECORDS DEPARTMENT

Comparative Totals I960 and 1959

1960

1959

Tabulated Requisitions — Records Pulled

117,097

109,081

(Excluding Department use and Research)

1960

1959

Telephone Calls 41,862

39,821

Records Pulled for Research

10,322

8,874

Patients Index — tabulated calls

79,926

53,045

New Records Issued

15,424

16,410

Discharges*

9,959

9,906

Total Operations (including Throat)

5,590

5,492

Correspondence (Requests handled)

5,477

5,409

Income

I960 1959

3,581.25 2,905.65

Photostating (pieces)

Inter-Departmental Transfers
401.75 557.10

Crippled Children — authorizations
Records Taken to Court

6,548

668

9,512

664

Explanatory Remarks: The items Discharges and Total Operations represent the
work of the collating clerk in preparing the records plus the work of the entire
secretarial section involving transcription and transmittal for signature. The
total number of records pulled and calls to the Patients Index, as shown, do not
represent the total amount of work actually performed, since it is impossible to
tabulate all requests actually completed.

134

REPORTS OF ADMINISTRATIVE DEPARTMENTS

PATIENT EDUCATION AND
RECREATION

The Department of Patient Education
and Recreation during I960 carried
out the objectives and activities set
forth by Mrs. Joyce Meyer, the co-
ordinator, who left the hospital in
September of 1959. Miss Marcelle
Hocquet, as senior, in I960 supervised
the activities of the nursery school
teachers in the three hospital play-
rooms in Building B. In the fall of
I960 Mrs. Nancy Cronce became the
play teacher in the House of the Good
Samaritan. The nursery school teacher
on Division 25 is subsidized by a grant
from the Daffodil Club. Mrs. Eva
Pahnke, at the same time, became a
part-time teacher in a classroom pro-
gram for children at the House of the
Good Samaritan. She is subsidized by
a grant from the Women's Committee.
Her principal duty is to develop a
program supplementing the bedside
instruction provided by the four teach-
ers from the Boston School Depart-
ment.

Mrs. Avis Bray has continued in
the office of the Department three
mornings a week and, in addition, has
continued to assume sole responsi-
bility for the evening program for
older children both in The Children's
Hospital area and at the Good Samari-
tan. The staff has continued its educa-
tional activities in the playrooms in
Building B. There have been twenty-
two student teachers from Wheelock
College, eleven each semester, for one
morning a week. In addition, there
has been one student from Garland
School four mornings a week for three
months and all day for three weeks.
Two students nurses have been as-
signed every two weeks for work on
a full day basis; a total of fifty-two
nurses have helped with the program.

Among the volunteers there have
been three Red Cross workers one
afternoon each week and others on the
average of five for one afternoon

a week. The evening program has
been somewhat more intensive; a total
of thirty volunteers have worked eve-
nings during the year at Children's
Hospital as well as twenty at the
House of the Good Samaritan.

Some of the playrooms were
closed during the summer months but
a survey of attendance for the six
months January to June, I960, shows
that the total average daily attendance
in all playrooms was thirty-three chil-
dren a day for five mornings a week.

The Committee on Patient Edu-

cation and Recreation continues its
search for a coordinator. There is
some difference of opinion as to
whether leadership should be selected
fiom people with an educational back-
ground or from those oriented in so-
cial work.

The Committee hopes that a
fuller degree of cooperation may be
achieved in the future with the Boston
School Department. The potentialities
of our Medical Center with respect to
the training of teachers of the handi-
capped are not being realized.

DAILY AVERAGE

ATTENDANCE IN

PLAYROOMS

FOR FIVE

MORNINGS

A WEEK —

1960

Playroom

Playroom 26

Playroom 27

January

February

March

April

May

June

6 mos. average

7.3

14.3

11.5

July

—

August

—

Total Average Daily Attendance — All Playrooms 33.1

PARTICIPATION IN PROGRAM BY

VARIOUS CATEGORIES OF WORKERS — I960

PLAY TEACHERS

Children's Hospital (daytime) 3

House of Good Samaritan (Miss Shirley Hicks) 1

Mrs. Avis Bray (evening program plus 3 mornings a week) 1

STUDENTS

Student Teachers — Wheelock College, 11 each semester one morning

a week 22

Garland School, 1 student for three months, four mornings a

week plus three weeks all day 1

Student Nurses — 2 every two weeks for eight hours a day with time

out taken for classes 52

VOLUNTEERS

Red Cross Volunteers — 3 one afternoon each week for textile or

clay work 3

Hospital Volunteers — 5 average one afternoon a week, evenings — 30 at

Children's Hospital, 20 at House of the Good Samaritan 20

135

REPORTS OF ADMINISTRATIVE DEPARTMENTS

PHYSICAL THERAPY

In reviewing the report of the Physi-
cal Therapy Department, it should be
remembered that it is more accurately
the report of the activities of all physi-
cal therapists in The Children's Hospi-
tal Medical Center who may be as-
signed to any one of several work
areas or departments. These include
the Cerebral Palsy Nursery School and
Clinics, the Massachusetts Infantile
Paralysis Clinics, the Mary MacArthur
Respiratory Unit and the House of the
Good Samaritan, as well as the out-
patient clinics and divisions of Chil-
dren's Hospital proper. Our respon-
sibilities also extend to the private
patients of any staff doctor.

Patient Care

Comparison of the statistical report
for the year ending September 30,
I960, with that of fiscal 1959, shows
a decrease of 8 per cent in the total
number of treatments given (31,158
vs. 28,902). This is most noticeable
in the polio out-patient clinics, where
a decrease of 25 per cent represents
a fairly large number of patients.
Other areas showing a marked de-
crease in referral of patients are
neurological, 75 per cent, neurosurgi-
cal, 50 per cent, and Infants' Hospital,
50 per cent.

Offsetting this was a 25 per cent
increase in treatments of polio in-
patients (9,600 vs. 7,000), mostly in
the first two months of the fiscal year.
Except for a slight increase in the
number of private out-patients, other
figures remained fairly constant.

Personnel

Corresponding to this drop in patient
load, we have decreased our staff by
one person. Our present number of
physical therapists is nineteen, one of
whom is part-time. The problem of
obtaining replacements continues to
be acute and at times necessitates cur-

tailment of patient load. There were
five resignations during the year, four
of them replaced. Three of the four
occurred in June, but replacements
were not available until September.
With a stable supervisory group we
can adjust to an annual turnover of
this number in the more junior cate-
gories. It is interesting to note that
the five senior (in tenure) members
of this department represent a total of
eighty-five years of service to The
Children's Hospital.

We have a secretary, clerk, and
attendant who are responsible for the
efficient management of the depart-
ment in the handling of appointments,
records, correspondence, accounting
and equipment. Since they also staff
a reception and information desk at a
very busy entrance, they are to be
commended for an excellent job of
public relations.

Education

The hospital continues its affiliation
with Simmons College in the formal
teaching and clinical supervision of
physical therapy students. Five mem-
bers of our staff hold faculty appoint-
ments at Simmons, including the Di-
rector, who also serves as technical
director of the program within the
School of Science. During the year
nine students who received the major
portion of their teaching here were
graduated with a B.S. degree and a
Diploma in Physical Therapy. There
are two classes of ten and seven each
currently under instruction.

Four students from Boston Uni-
versity's Sargent College and four
from the Bouve-Boston School of
Tufts University were accepted for
supervised clinical practice. One mem-
ber of the department also serves as a
member of the Corporation and of the
Executive Committee of the Bouve-
Boston School.

136

REPORTS OF ADMINISTRATIVE DEPARTMENTS

We have provided roughly 150
hours of teaching for the Nursing
School, nursing affiliates and medical
students. This is an average annual
amount and does not include many
hours of informal teaching with the
resident staff.

Two post-graduate courses on
physical therapy in the treatment of
cystic fibrosis were offered, in Novem-
ber of 1959 and June of I960. There
were ten (maximum enrollment) in
each group, representing nineteen dif-
ferent hospitals or clinics in twelve
states. This method of treatment was
developed in this hospital and has re-
ceived rather widespread attention.
Demand for additional courses con-
tinues.

Miscellaneous

Representatives from the department
have attended five conferences or edu-
cational institutes of short duration.

We have had many applications
from foreign physical therapists who
wish six to twelve months of affiliation
here as trainees under the Exchange
Visitor Program. Unfortunately, our
budget has not permitted considera-
tion of these applications, with the ex-
ception of one from Trinadad who was
sponsored and financed by the Inter-
national Cooperation Administration
for a six-week period.

We have had many visitors from
other countries as well as from differ-
ent states in this country.

We have been pleased to partici-
pate in various public relations activi-
ties, particularly in reference to out-
side agencies such as the National
Foundation and United Cerebral Palsy.
This has involved arranging for photo-
graphs, demonstrations, tours and in-
formal talks to interested groups.

Shirley Cogland

Director,

Physical Therapy Department

ANNUAL REPORT OF THE PHYSICAL THERAPY DEPARTMENT

October 1959 to September I960

Individuals
Polio Cases in the Hospital 234

Treatments
9,602

SERVICES (excluding polio)

Division 37 — Medical 73 545

Division 26 — Orthopedic 276 2,964

Division 36 — Orthopedic 149 1,773

Division 71 — Respiratory Unit 10 396

Division 72 — House of the Good Samaritan 10 698

Division 73 — House of the Good Samaritan 11 550

Division 25 — Private 24 394

Division 24 — Surgical 13 203

Division 34 — Surgical 16 240

Division 39 — Neurological 21 36

Division 35 — Cardiac 9 157

Division 28 — Tumor Therapy 10 127

Division 27 — Infants' 19 259

Division 33 — Neurosurgical 33 255

Division 14 — Throat 3 4

HOSPITAL PERSONNEL

BADER BUILDING OUT-PATIENT
General Clinic
Privates

Cerebral Palsy Clinic
Cerebral Palsy Nursery School
MIPC Outside Clinics

911

18,203

149

941

18,352

675

2,134

499

1,735

—

919

—

675

—

1,668

29,004

137

REPORTS OF ADMINISTRATIVE DEPARTMENTS

PERSONNEL

In the past fiscal year nearly 1700
people have been interviewed by mem-
bers of the Personnel Department.
The majority of these applicants came
to us independently, with approxi-
mately twenty per cent responding to
advertisements in local papers, and
about thirty per cent being referred
either by an agency or a friend. Not
included in any of these figures are
potential members of the nursing
staff, who are seen only in the Nursing
Office.

About 600 employees left in the
past year, with the highest percentage
of turnover in Nursing Service and
those departments in the service areas.
In reviewing the reasons for termina-
tion, we have only the information
which the department head or super-
visor has supplied on the termination
report, as the Personnel Office does
not at this time conduct terminal inter-
views.

One of the most important proj-
ects of this department was the much-
needed employee handbook, although
the actual publication and distribution
will not take place until the beginning
of the next fiscal year. This booklet
will be given to all current employees
and to each new employee when he
comes on payroll.

On October 1, 1959, a new bud-
get system was established by Adminis-
tration which brought new responsi-
bilities to this department. Procedures
and forms were adapted to insure that
all salary rates and number of em-
ployees are kept within budgetary
limits.

Throughout the year we have
conducted several surveys both here
and in other hospitals in the Boston
area to keep our policies and salary
scales consistent with these neighbor-
ing hospitals.

In May of this year, we had the
first Annual Service Pin Award cere-

mony. Before then, each department
head had presented the service pin to
an employee on the anniversary of his
tenth year of employment. All em-
ployees who have had five or more
years' service are now invited to this
annual event.

In fiscal 1961 there are many pro-
grams to be developed by the Person-
nel Department to improve its services
to the Hospital and its patients. The
programs must focus on improved
human relations and better working
conditions for all employees.

Specifically, the following plans
should be inaugurated to attain these
objectives:

1. Develop and publish person-
nel policies and procedures
which will be equitable for all
employees.

2. Establish an adequate wage
and salary system based on
recognized job evaluation
techniques, so that employees
are paid in relation to work
performed.

3. Intensify recruitment efforts
to provide sufficient and
proper personnel.

4. Formalize personnel records
to provide adequate service to
supervisors and employees.

5. Establish an improved budget
control system.

There are many other programs
that must be established in the future
to provide improved service to our
patients, such as training courses,
orientation courses, improved records
and statistics, but if the above can be
accomplished this year, I feel that a
good start will have been made.

Alexander T. Brown
Personnel Director

138

REPORTS OF ADMINISTRATIVE DEPARTMENTS

VOLUNTEER SERVICE

Volunteers donated 41,28214 hours of
their time in the past year in Volun-
teer Service work to assist the profes-
sional staff in making our patients and
their parents feel "comfortable and
safe." While the burgeoning growth
of the past five years, during which
the hours of service increased from
25,800 to the present total, seems to
have leveled off, we have experienced
no sense of being less busy nor have
any requests for assistance been long
unfilled.

The Library volunteers have con-
tinued to supply an outstanding serv-
ice while handicapped by their new
and meager quarters. It has not been
possible for the same number of
women to work in such a tiny space
but they have more than compensated
by the quality of service they have
continued to give the patients.

The branch library, at The House
of the Good Samaritan, has grown to
be an important factor in the conva-
lescent patient's day.

We were fortunate in obtaining
pupils from the Boys' Latin School
Key Club to help prepare the plaster
casts, a dusty job that held no appeal
for female volunteers.

The Gift Shop, under Mrs. H.
Raymond Wilkinson's guidance, and
the Coffee Shop, under Mrs. Samuel
S. Stevens' chairmanship, continue to
give the same high quality of service
as in the past and to show a respect-
able profit.

During the summer months
when, because of family responsibili-
ties, the older women are unable to
fulfill their volunteer commitments,
seventy-eight teen-agers served more
than 8,000 hours. They were students
at thirty-eight high schools and col-
leges. The volunteer department sent
a letter to each school, informing them
of the students' summer activities.

A group of Harvard Medical
School wives met twice a month to
make surgical dressings.

A Volunteer Service Committee
was formed in April to assist and ad-
vise the Director of Volunteers. It in-
cludes two members of the Women's
Committee, chairman of Staff Wives,
president of House Staff Wives Com-
mittee, Director of Nursing Service,
a representative from the Medical
Staff, the executive secretary of the
Women's Committee and, ex-officio,
the Director of The Children's Hospi-

tal Medical Center and the Chairman
of the Women's Committee. The com-
mittee assisted with the Evening Party
for volunteers. I look forward to con-
tinued guidance from the committee.

I was privileged to attend the
initial Workshop for Directors of Hos-
pital Volunteers at Boston University.
The Workshop was instituted at the
urging of the Greater Boston Council
of Directors of Hospital Volunteers,
and proved to be so successful it is this
year being sponsored by the Massachu-
setts Hospital Association.

HOURS OF VOLUNTEER

SERVICE

Oct. 1959

Oct. 1958

SERVICES

Sept. I960
1,346

Sept. 1959

Administrative Aides

2,0471/2

Admitting Hostesses

1,4213^

1,4571/4

Blood Bank

34834

34134

Central Supply

—

Christmas Decorations

751/2

—

Feeding

1,04414

l,02U/ 2

Gift Shop

6,8941/2

9,26734

Good Samaritan

3,3171/4

—

Information Desk

4201/2

4811/2

Laboratory

1,32914

Library, Patient

1,031

2,1973/4

Lunch Shop

7,447

8,195

Medical Records

1431/2

—

Mended Hearts

11/2

Parents Teas

2161/2

208

Pharmacy

—

Photography

162

1131/2

Plaster Room

5751/4

—

Post Office

183 1/2

27434

Recreation

3,0301/2

5,9801/2

Red Cross Aides

799

9411/2

Social Service

681/2

671/2

Surgical Dressings

9531/2

6791/4

Transportation

4,993i/»

3,994^4

Volunteer Aides

1,9641^

3,295i/2

X-Ray

329 3 4

Totals

41,2821,4

44,1801/2

139

REPORTS OF ADMINISTRATIVE DEPARTMENTS

DIETARY

As a member of The Children's
Hospital Speakers Bureau, I gave talks
before several fraternal organizations,
church groups and to The Jordan
Hospital Auxiliary. I served as chair-
man of the committee to re-vamp the
by-laws of the Greater Boston Council
of Directors of Hospital Volunteers
and for a two-year period will be the
recording secretary of the council.

A salaried secretary has fulfilled
a long-standing need in the volunteer
department.

The attached statistical report in-
dicates the various types of work our
volunteers are performing for the hos-
pital, but does not relate even a part
of the devotion given to this institu-
tion by the volunteers.

I would like to express my deep
appreciation to Administration, Staff
and the Women's Committee for their
continued support and assistance, and
to the Volunteers who make the report
necessary and possible.

Kathleen Higgins
Director, Volunteer Service

The dietary department of The Chil-
dren's Hospital Medical Center has as
its primary responsibility the prepara-
tion of all meals for its patients, in-
cluding those of the Judge Baker
Guidance Center School. In addition
to this and far more time-consuming
is the operation of the staff and em-
ployee cafeteria which often provides
more than 2,000 meals per day.

During the past year our depart-
ment served 240,030 regular meals
and 29,565 special diet meals to pa-
tients. In the staff and employee cafe-
teria, 491,558 meals were served. In
addition to providing these meals, the
department is called upon to supply
refreshments to such areas as the blood
bank, the surgeons' and scrub nurses'
lounges and to many of the meetings
and conferences held at the Medical
Center.

The dietary department has a
staff of 65 (41 full-time, 24 part-
time) persons who plan all meals, pur-
chase and prepare all the food, and
serve in the cafeteria.

Meals for the patients are pro-
vided in bulk in heated trucks to the
floor or sub kitchens where they are
put on trays and served by the nursing
department. The management of the
floor, or sub kitchens on the patient
divisions by the nursing department
is under study and it is possible that
the dietary department will assume
that responsibility during the coming
year. This should relieve the nurses
and their aides of the tasks of setting
up patients' trays, give the dietitians
better control over the management
of these kitchens, and provide for
more direct contact between patient
and dietitian.

With the exception of the main
kitchen, the activity of the dietary de-
partment has far outgrown its present
quarters. The staff and employee din-
ing room serving facilities and dish-

washing equipment are no longer ade-
quate to handle the volume of feed-
ing. Long lines waiting at the cafeteria
at meal time give evidence to this
problem. The immediate need here is
to increase seating space in the dining
room, enlarge and improve the dish-
washing facilities, and add another
serving line or increase our present
serving facilities.

Martha Stuart
Head Dietitian

140

REPORTS OF ADMINISTRATIVE DEPARTMENTS

PURCHASING

In the past year the Purchasing De-
partment has experienced the in-
creased activity that naturally would
be associated with the vast expansion
in all Hospital departments. Changes
in personnel and additions to existing
staff are immediately reflected in this
department in the requests for office
furniture, typewriters, medical and
surgical supplies, instruments — in fact,
any or all the tools required to accom-
plish the projected assignment.

In the early part of the year Mr.
Joseph P. Greer outlined and effected
certain necessary changes in purchas-
ing procedure by Hospital departments
from General Funds. To take full ad-
vantage of centralized purchasing it
has been necessary to insist that all
requisitions be processed via Purchas-
ing after receiving administrative ap-
proval. The routing of all orders
through a single office has prevented
duplication of shipments and allowed
combination of identical orders result-
ing in competitive and quantity pur-
chasing.

Some 15,000 purchase orders
were sent to vendors, each resulting in
a subsequent invoice which was
checked as to receipt, verified for pric-
ing, coded and forwarded to Account-
ing for payment. A perpetual inven-
tory is kept on 1,500 items stocked for
general use, including medical, surgi-
cal and laboratory supplies, blankets,
sheets, pillow cases, printed forms,
stationery and office supplies.

Our hospital is a charter mem-
ber of the local Hospital Purchasing
Corporation, founded in 1952, and the
Purchasing Agent is a member of the
Standardization Committee working
with this organization. A recent arti-
cle appearing in the Journal of the
American Hospital Association re-
cords a most enlightening appraisal of
seven successful years of group pur-
chasing. Bi-weekly committee meet-

ings are held, and every possible means
of effecting savings is explored and
utilized. Pooling both the knowledge
and supply requirements of many Hos-
pitals in the Boston area into large
volume purchases with definite speci-
fications or standards is one proven
way of obtaining substantial savings
without sacrificing quality. An inter-
esting and current topic is the trend
toward the contemplated use of "dis-
posables" as a change from the stand-
ard (reusable) product in many sec-
tions of the Hospital, Patient areas —
Laboratories — Central Supply Service,
etc. These disposables are designed for
convenience, utility, and economy in
saving valuable time by eliminating
such tedious tasks as cleaning, wash-
ing, sterilizing, since the item is used
once and discarded.

While labor-saving studies reveal
that the time and wages of personnel
involved in preparing reusable items
are the compensating factor, the cost
is an all-important consideration.

To point up the increase in cost
on one item in general use between
patient division and Laboratories, the
following statistics are revealing. A
glass specimen collector purchased in
quantities of one gross per year at a
total cost of $130 for the year has been
replaced by a one-time use article at a
cost of $3,000 per year. This increase
in expense is offset, first, by the safety
factor which had long been desired,
second, by sterility, and, third, by prob-
able savings in labor. None of these
considerations can be evaluated on a
dollar basis.

The staff presently consists of the
Purchasing Agent, Assistant, two pur-
chase order clerk-typists, an inventory
clerk and an invoice clerk. In the Re-
ceiving Room we have the head Store-
man, an Assistant and three helpers.
With the exception of one helper
added to the Receiving Room Staff last

summer, this is the same number of
employees serving in the department
ten years ago. This staff is not con-
sistent with the expansion previously
referred to, but anticipated changes in
processing Special Fund activities is
under consideration, and much clerical
work not essentially purchasing may
be channeled elsewhere.

Elizabeth Fitzgerald
Purchasing Agent

VISUAL EDUCATION

141

REPORTS OF ADMINISTRATIVE DEPARTMENTS

In reviewing the past year's work it is
informative to list the many kinds of
photography employed by the Depart-
ment in its production of material for
visual education in the medical field.
We photograph patients for the medi-
cal record, which is a basis for teach-
ing material and an invaluable pic-
torial record of the individual patient's
progress to health. We make motion
pictures of gait, growth and neurolog-
ical problems. From time to time
teaching motion pictures of surgical
procedures are made. Magnetic sound
is added if needed and is recorded
here. We do a great deal of color
photography for many purposes, but
do not produce color prints. We make
standard and 2x2 lantern slides in
large quantities. We do both photo-
macrography and photomicrography.
A lot of flat copy is made as the first
step in making lantern slides and
prints. We illustrate scientific papers
and books. Several thousand X-rays
are reproduced each year as prints and
lantern slides. Exhibits for the many
departments and services of the hos-
pital are planned and made as needed.
We are consultants on technical photo-
graphic problems related to the bio-
photographic field. We also do spe-
cialized photography by infra-red
light and occasionally under ultra-
violet light. Much laboratory equip-
ment requiring highly specialized
lighting conditions is also photo-
graphed. New applications of photog-
raphy are constantly being found use-
ful in the medical field.

Our patient load showed an in-
crease of over five hundred photo-
graphs in the past year. An increase
of 44 per cent was noted in the pro-
duction of 2x2 (35mm) black and
white lantern slides. Standard lantern
slides increased 36 per cent. Motion
pictures increased by 13 per cent. The
trend is ever upward.

Thanks to the Women's Com-
mittee, whose grant of funds enabled
us to purchase an electronic printer,
we are now able to produce much
better prints of X-rays than before.
The machine is also very useful in
difficult photographic printing prob-
lems involving patients. We are most
appreciative.

It probably will be necessary to
hire someone for vacation relief dur-
ing the coming summer. This year
the problems were most difficult with
a vacation period spreading from late
June to the end of September. We
are operating the department with a
total staff of four, while in other in-
stitutions doing an equal volume of
work the staff is usually six persons.
So far we get along very well when
the whole staff is present.

In August I attended the annual
meeting of the Biological Photo-
graphic Association at Salt Lake City,
Utah. Several new techniques may
have application here, after further
study.

The one paper published this year
is "Radiographic Reproduction," F. R.
Harding, FBPA, Jour. Biol. Photo.
Assn. Vol. 28 #2.

This has been a very busy year
for the department. I wish to thank
the staff for its cooperation. I should
like to especially thank my own staff
for their wholehearted cooperation.

F. R. Harding, Director
Visual Education Department

STATISTICAL REPORT OF DEPARTMENT
OF VISUAL EDUCATION I960

Service
Orthopedic
Surgical
Neurosurgical
Medical

Tumor Therapy
Infants' Hospital
Pathology
Private Division

Cases Photos

559 2037

262 705

112 270

605 1249

472 1438

55 115

375 731

384 1142

Private Office Patients 193 536

M.I.P.C. 35 114

C P. Clinic 17 126

Neuro-medical 18 66

Child Health 7 12

Adolescent Clinic 13 31

Dental Clinic 9 33

New Born Nursery 2 7

X-Ray Therapy 6 14

Seizure Unit 2 3

Respirator Unit 1 2

Total 3152

8725

Misc. Negatives

2594

Misc. Prints

5632

Black & White Lantern

Slides 2x2

1532

Black & White Lantern

Slides Standard

1624

Color Slides 2x2

446

Color Slides Standard

220

Motion Pictures

315

Motion Picture Footage

14,310 ft.

Total Negatives

11,298

Total Prints

14,357

Total Charges

$16,222.20

142

REPORTS OF ADMINISTRATIVE DEPARTMENTS

PHARMACY

The fiscal year I960 was eventful for
the Pharmacy. In June, it moved into
the area formerly used by the blood
Donor Department, giving the Phar-
macy 250 square feet of good work-
ing space and space for the efficient
storage and dispensing of most phar-
maceuticals used in the hospital.

The inner room of the old Phar-
macy was retained and plans have
been drawn to use it for manufactur-
ing bulk pharmaceuticals, sterile in-
jectable vials, washing bottles and the
storage of some state-owned drugs.
All volatile solvents, including alcohol
and ether, must be stored in the cellar
beneath the Admitting Office to con-
form to fire and safety regulations.
These heavy materials are lowered
from the street level by means of a
hand-operated, antiquated elevator
only to be carried to the street floor
by means of a dangerous spiral stair-
way, when needed for use within the
hospital.

The volume and value of the
drugs dispensed by the Pharmacy was
approximately $250,000 in the past
year. The advent of antibiotics, such
as penicillin, chloramphenicol, erythro-
mycin, has increased the cost of oper-
ation tremendously but has reduced the
average patient stay in the hospital.

The Pharmacy of the Children's
Hospital is confronted with different
problems than other hospital pharma-
cies because it must dispense medi-
cines in a suitable dosage range con-
venient for the nurse to administer
and palatable to the child. Most phar-
maceuticals are manufactured for
adults with little or no attention di-
rected to pediatrics. Examples:

Several strengths of sterile nar-
cotics are prepared in the Pharmacy
and are available in graduated vials
for the convenience of the nurse in
accounting for these drugs. The Phar-
macy annually prepares approximately

1000 of these vials, which are not
commercially available because of the
small doses required for children.

Tablets and capsules of drugs
containing adult doses, but used for
children, are quickly diluted and made
into capsules of convenient doses by
means of a hand operated capsule ma-
chine capable of making 100 capsules
at a time. This same machine is also
used to make capsules of investiga-
tional drugs. A few of the important
capsules made with this machine this
year were potassium perchlorate 250
mg., penicillamine 250 mg., neomycin
sulfate 100 mg. and 250 mg., and
isoniazid 10 mg.

Approximately 5000 five Gram
vials of penicillin were reconstituted,
or dissolved, under aseptic conditions,
properly labeled with strength and
expiration date this past year. This
penicillin, along with streptomycin
was delivered to the divisions three
days weekly, at which times the sup-
plies were checked for expiration
dates and supplies replenished, if
needed. Considerable saving in nurs-
ing hours resulted.

It is the intention of the Phar-
macy to supply chloramphenicol,

erythromycin in a ready to use, sterile
vial in 1961 rather than to send it to
the division in a dry form, requiring
its reconstitution by a nurse. This can
be accomplished by the addition of a
freezer, which will allow the prepara-
tion of many vials at one time. Most
of these drugs are quite stable in the
frozen condition but quite unstable in
liquid form.

Routine stock drugs for the di-
visions were delivered daily upon re-
ceipt of a requisition and all empty
bottles and returns were picked up
on this delivery. Many special medica-
tions for individual patients were de-
livered to the divisions at this time.

The Pharmacy is always glad to
aid any laboratory or doctor to obtain
any hard to get chemical and to pre-
pare it in a convenient dosage form,
if desired.

The most time-consuming job in
the Pharmacy is the dispensing of
prescriptions to out-patients; these
number over 100 daily. Drug stores
figure it takes six minutes to dispense
a simple prescription, but much less
time is required here.

The Pharmacy, in addition, dis-
penses, and accounts for all the vari-

RELATIVE CONSUMPTION OF DRUGS BY PROGRAM OR SERVICE

Chronic disease program
prescriptions

Out-patient prescriptions

Laboratory supplies

Division supplies

Cancer Research Foundation

antibiotics

FIGURE I

143

REPORTS OF ADMINISTRATIVE DEPARTMENTS

SPECIAL SERVICES

ous drugs used under the Chronic Dis-
ease Program and purchased by the
Commonwealth of Massachusetts.
About 1200 patients with cystic fibro-
sis, requiring from one to 12 individual
drugs, and about 1000 seizure patients,
requiring one to five drugs each time,
were served by the Pharmacy. The
average state-owned inventory stored
in the Pharmacy is about $25,000.

A detailed monthly report is pre-
pared for the Administration and
Comptroller, with special sections for
the Health Department of Massachu-
setts, Director of Nursing, and the
Cancer Research Foundation. This
report furnished the Administrator
and Comptroller with the cost of drugs
dispensed to patients, divisions, labo-
ratories as well as the charges to the
patients.

The Pharmacy is staffed by four
pharmacists, including the chief phar-
macist, and one helper. It is apparent
from this report that the staff is hardly
adequate to accomplish all that is
necessary. It is hoped that an addi-
tional pharmacist, secretary, and office
space for the Pharmacy may be ob-
tained in the coming year.

Arthur M. Thompson
Chief Pharmacist

This new administrative department
was established this year for more ef-
fective supervision of our parking lots,
security program, elevator operators,
apartment houses and grounds. It also
will be responsible for many of the
administrative arrangements of special
functions held at the hospital.

1. Parking Lots.

The parking management pro-
gram has been functioning effectively
for two years. Basically it requires all
parents, visitors and staff to pay 25
cents daily for parking and all regular
employees and staff $2.00 per month.
Volunteers and unpaid house staff are
issued free permits. The proceeds, ap-
proximately $35,000 per year, are used
to pay for professional parking at-
tendants and for the physical main-
tenance of the lots.

The increased number of places
resulting from more efficient use of
our available space has brought a
favorable reaction, particularly from
our out-patient parents. Many com-
ment that prior to the establishment
of this system it was extremely diffi-
cult to get their children into our
clinics because they were unable to
park near the Hospital. The 2 5 -cent
fee is established only to cover the
cost of operating the lots.

2. Security program.

The Hospital purchases the serv-
ice from an established detective
agency. It provides both a crew of
uniformed night watchmen and the
services of a licensed detective if
needed. The difficulty of policing our
seventeen buildings, covering several
city blocks, most of which are open
twenty-four hours a day, cannot be
overstated. As in any institution, the
most effective safeguard against losses
is alertness and care on the part of its
employees and staff.

3. Apartment Houses.

The Hospital owns forty apart-

ments at 329 and 333 Longwood Ave.
In addition it now has thirty-five to
forty rental rooms at the House of the
Good Samaritan Nurses Home at 19
Peabody Street. The majority of the
apartments are rented to members of
the nursing staff at somewhat below
the local rates. The rooms at 19 Pea-
body Street are assigned to the female
house staff, staff nurses and employees.

4. Grounds and Landscaping.

Our present grounds crew num-
bers four and is charged with main-
taining our lawns, shrubbery, remov-
ing snow, decorating for holidays and
countless other tasks.

George T. Nicoll,
Director, Special Services

COMMUNICATIONS

The extensive and ever-increasing use
of hospital telephones places heavy de-
mand on our operators, our switch-
board and our budget. We require
twelve operators to give round-the-
clock coverage of thirty-five outside
lines and nearly 700 hospital tele-
phones.

Equally important is the respon-
sibility placed upon the operators for
tracing the location of hundreds of
staff and resident doctors and other
key personnel. Extensive directories
and call lists are maintained for this
purpose but the operators' memories
are the key to this service.

The cost of telephones, exclusive
of salaries, for the past year was ap-
proximately $110,000 or nearly $329
per day.

Ruth C O'Brien
Chief Operator

144

REPORTS OF ADMINISTRATIVE DEPARTMENTS

EMPLOYEE HEALTH SERVICE

The Employee Health Service was in-
augurated as a new department at The
Children's Hospital Medical Center in
January, 1959. Following a survey of
nine hospitals in the Boston area re-
garding policies and services for em-
ployees and subsequent administrative
consultation, it was deemed wise to
establish our program on a limited
basis and thus determine the needs and
requirements of this hospital.

Although the department has
been functioning for only twenty-one
months, a fairly rapid development
has demonstrated the need and use of
this service by employees. All hospital
personnel, with the exception of stu-
dent nurses and staff nurses, are cur-
rently covered by this service.

The incidence of time lost from
Industrial Accidents has been substan-
tially reduced. Minor injuries can be
treated at the Employee Health Service
with a minimum of time being spent
away from the department. Hereto-
fore, injured employees were referred
to a clinic and the usual delay of Out-
patient care frequently involved many
hours. In view of the fact that there
is no historical background, it is diffi-
cult to estimate this saving in dollars
and cents.

Pre-employment physical ex-
aminations, medical advice, check-ups,
nursing consultations, ancillary serv-
ices when indicated, polio inoculation,
travel immunization, influenza vac-
cine and referrals to other hospitals
and/or private physicians constitute
the service offered. This program pro-
vides one more fringe benefit offered
by The Children's Hospital Medical
Center to its employees.

On July 1, I960 The Children's
Hospital Staff Association employed
the professional services of Dr. Robert
J. MacMillan to give medical care,
physical examinations and complete-
immunizations. This service for the

House Staff is provided in the Em-
ployee Health area.

In March, I960, a tentative pro-
gram providing health coverage for the
Judge Baker Guidance Center em-
ployees was submitted. Formal ar-
rangements on a contractual basis have
been approved.

It would be an omission not to
point out two factors that are impor-
tant to the service in the future.

(1) The Employee Health Serv-
ice is infringing on the Per-
sonnel Department space
which is shared as a waiting
area for prospective job ap-
plicants and ill employees.

(2) The Children's Hospital
Medical Center is spending a
substantial amount of money
for health service. As we
look to the future, a co-
ordinated plan for health
services for all employees
should be contemplated
with increased medical cov-
erage, more clearly defined
policies and improved fa-
cilities. The hospital would
benefit immeasurably by
such a program.

A summary of statistics is attached.

Hester E. Macuen, R.N.

Director,

Employee Health Service

STATISTICS FOR

EMPLOYEE HEALTH SERVICE

Physical examinations 436

Medical visits and check-ups 631
Nursing visits and

consultations 1,347

Polio inoculations 230

Polyvalent flu vaccine 335

Other immunizations 57

Total 3,036

Average monthly visits 253

Referred for X-Rays— CHMC 58
Referred for Lab Work— CHMC 54

Referred for E.K.G.— CHMC 9

Industrial Accidents treated 64

Referred to Peter Bent Brigham 36

Referred to Mass. Eye and Ear 8

Referred to Other Hospitals 8

Referred to Private Physicians 51

Safety Committee. The Medical Cen-
ter's Employee Safety Committee has
met monthly during the past year and
carefully reviewed every on-the-job
accident. There are about twelve mem-
bers representing the major depart-
ments.

In addition to investigation of
each accident with an eye to eliminat-
ing the cause, the committee sponsors
safety publicity, maintains a safety
bulletin board and makes many recom-
mendations on working hazards.

The Workmen's Compensation
self-insurance program has again
meant considerable savings to the
Medical Center. Costs for the calendar
year I960 should be well below 50 per
cent of our normal premium. The
number of accidents involving lost
time continued to decline during
1960.

MAINTENANCE

145

REPORTS OF ADMINISTRATIVE DEPARTMENTS

This past year probably can be con-
sidered a more nearly normal year for
the Maintenance Department than
those immediately preceding because
the basic remodeling program, started
in 1956, had been substantially com-
pleted. While the activities of the de-
partment have not been as frenetic as
those other years, there seems to be a
level, about that of a dull roar, below
which it seems The Children's Hospi-
tal Medical Center does not operate.

As far as large construction high-
lights are concerned, there are not
many to report. The pharmacy dis-
pensary was re-designed and moved to
the location of former blood donor
rooms with slight alterations. De-
centralized out-patient cashier facili-
ties and several laboratories were de-
signed and installed. The student
nurses kitchen in the Gardner House
was modernized. And, of course, con-
siderable numbers of air conditioners,
sinks, counters, refrigerators and freez-
ers, etc., were installed, all requiring
power or plumbing facilities.

That the institution is constantly
becoming more machine equipped
throughout is apparent in the increase
in the amount of electrical power used
each year. The power consumption in
1959 was 15 per cent higher than in
1958. Early this year a new trans-
former was installed near the Main
Building and considerable switching
changes were made for the Carnegie
and House of the Good Samaritan
buildings to correct unbalanced loads
created by our increasing new de-
mands. These installations were made
without incident, though many power
shutdowns were involved.

Much of our activity relates to
"fixing" things for other departments.
In the cause of record simplification
we do not keep complete cumulative
records of all work performed. But
October's activity may be considered

as normal to show what is done
throughout the year. About 100
maintenance orders were received
from the various departments to re-
pair, fix, or adjust equipment involved
in their operation. A sampling shows
this variety:

Aquarium pump, toasters, scales,
stethoscope, laundry truck, TV's,
hot pack machines, hi-fi's, deep
freeze, isolettes, go-carts, step-
ladder, radios, hair dryer, tables,
lamps, bottle warmer, respirators,
etc.
Much more of this work was per-
formed on a routine maintenance
basis, such as sterilizer checks, iso-
lettes cleaned or repaired, plaster
traps cleaned, air filters replaced, etc.
To this routine is added the phone call
load, varying from day to day but esti-
mated at several hundred a month, to
perform similar jobs of urgent nature.
There are about 1,500 rooms of
various kinds in our main building.
Mr. Morris J. Reardon, our "light bulb
man," replaced 785 light bulbs in
those rooms during October and in
addition traversed every corridor and
stairwell in Buildings A, B, C and Bader
each day checking and replacing bulbs.
This represents our basic lighting
maintenance program, for which we
use about forty-five different sizes and
types of bulbs. Along this same line
we purchased in the past six months
about 250 electronic tubes of great
variety for use in our increasingly
complex equipment, such as medical
record card files, pneumatic tube con-
trols, TV and radios, and the potwasher
for the main kitchen.

We made things, too, for the
other departments; in October we pur-
chased 2,080 square feet of plywood,
masonite, etc. and 500 linear feet of
1 x 12 lumber for tables, counters,
shelving, etc. Our own painting de-
partment bought (and used) 409 gal-

Ions of paint last year. Considerable
contract painting also was performed.

During the year, amidst the re-
pairing and building for others, roofs
were fixed, sidewalks patched, snow
cleared, cars parked, sinks unplugged,
washers changed, fuses replaced, signs
made, bearings oiled, traps cleaned,
pumps repacked, rooms painted, floors
repaired, pictures hung, leaves raked,
lawns mowed, clocks set and keys
made.

And finally we succumbed to pub-
lic opinion and renovated our office.
It now looks so nice that eviction
notices would come as no surprise.

Arthur Stomberg
Plant Superintendent

146

REPORTS OF ADMINISTRATIVE DEPARTMENTS

SURGICAL APPLIANCE SHOP

In the period from June 6 to October
1, the Surgical Appliance Shop has
tried to center its interests on the fol-
lowing problems:

1. To ascertain an accurate hourly
rate, based on over-all costs, which can
be applied toward a review of prices
generally as well as repair work. In
the area of overhead expenses, we plan
to pin down the cost to the Depart-
ment for vacations, holidays, coffee
breaks, stationery, etc., and relate them
to the over-all cost of braces in
general.

2. A cost analysis of the manufac-
ture of our braces (leg braces in par-
ticular). We have been concerning
ourselves not only with the cost of
machining and forging our own parts
for leg braces, but also with the labor
time involved in the assembling and
finishing. We are also trying to deter-
mine an average time for measure-
ments and fittings.

3. The time-clock work-cards
which we now use: These cards are the
means by which we obtain our labor
costs for a given brace. However, the
system we presently have distorts the
picture for us and has delayed our pre-
senting any final figures as to the pres-
ent cost of manufacture of any particu-
lar type of brace.

4. The constant flow of repair
work which comes in to this shop in-
terrupts the production flow of new
appliances, and causes, to the staff and
patients, exasperating time delays in
delivery. There is no question in my
mind but this problem will be with us
for some time, because it is related to
our present brace design. As new de-
signs are accepted by the staff, we ex-
pect to eliminate gradually the bulk of
repair work. It has been my experi-
ence in the past that the one type of
repair work that cannot be eliminated
is the replacing of leather on various
splints, since there is at present no

covering material available that will
last the life of the brace itself.

5. The methods of prescribing,
and more especially the prescription
forms now available to the staff, are a
source of annoyance to both the staff
and the department for the reason that
no accepted nomenclature has been
worked out. At present this lack of a
common terminology leads to many
problems, especially remaking, because
of misunderstandings; and as is so
often the case, the patient is not seen
by the braceman, and therefore the
doctor's prescription should be precise
and complete.

6. We find that in the past there
have been several men doing measur-
ing and fitting, each having his own
methods. This, of itself, is not bad,
provided each individual method is
based on sound knowledge. The weak-
ness of too individualistic an approach
makes for unnecessary complications
in production control and efficiency.
When each man has his own tech-
nique, he alone is the only one who
can follow through to completion on a
particular brace. A series of instruc-
tion sessions are planned (tentatively
one hour per week) in which we aim
to combine the best fitting techniques
of each individual and have the group
adopt them. We also would like to
include in these sessions a spelled-out
method of measuring for various ap-
pliances in terms of anatomical land-
marks. We feel that this will enable
all of us to understand one another
better, and will facilitate more flexible
assignment of the work.

7. There are a number of types
of braces, such as Whitman plates or
any spinal brace which requires a
form-fitting mold, which necessitate a
negative cast taken on the patient,
which in turn is used to make a posi-
tive model to which the molded sec-
tions are shaped. Presently these nega-

tive molds are taken by the physician
or plaster technicians in the O.P.D.
plaster room. The patient would not
be seen by the braceman until many
hours of labor and much material had
been used on the brace, whether the
brace would be in the fitting or com-
pleted stage. This practice is extremely
wasteful and is very unsatisfactory to
both physician and patient, since often-
times what has been completed is in-
adequate and must be discarded, or
remade in such a manner that ma-
terials and labor will be doubled. This
problem will somewhat solve itself in
the future, since we hope to cover the
clinics more closely and give better
service to the staff. In this way, we are
on the spot when a brace is discussed
and can see the problems first-hand
and get whatever further details we
feel will be necessary before starting
the appliance. This should save a con-
siderable amount of extensive altera-
tions.

8. When a brace is completed,
rather than have the patient come to
the Appliance Shop for a final fitting,
the brace is sent to the clinic, and the
clinic in turn notifies the patient to
come in. The brace is then applied at
clinic by the physician. Consequently,
little minor adjustments which mean
so much to patient comfort have to be
done on the spot without being
planned. The doctor's time has been
wasted on the obvious, examining
rooms in the clinic are tied up un-
necessarily, and it is my feeling that,
most important of all, a good relation-
ship between the department, physi-
cian, and the patient is seriously com-
promised.

The system of brace deliveries
has been revised, and seems to be
working quite well. Instead of our
sending the brace to the Clinic for ap-
plication by the physician, we now
notify the Clinic when a brace is fin-

147

REPORTS OF ADMINISTRATIVE DEPARTMENTS

HOUSEKEEPING

PRINT SHOP

ished. The patient is sent an appoint-
ment by the Clinic; he registers, and is
sent to the Appliance Shop. The brace
is then put on him at the Shop, and
minor adjustments can be caught then
and there. When the brace is satisfac-
torily fitted, the patient is sent to the
Clinic and the Doctor gives the brace
a final check. To date, with this
method, we have caught many minor
details in advance of the Clinic, and
we believe it will save a good many
people's time in the future.

Perhaps in the future it would be
wise to think about combining in this
area some general information for the
patients or their parents which would
instruct them in maintenance of the
brace in terms of longer life and less
repair. It is possible that the best ap-
proach to this maintenance problem
would be a few simple instructions
printed on a card and given to each
patient at the time the brace is re-
ceived. We feel that little is done
along these lines in the Clinic area
since no one has the time to do so.

Inventory system. In the coming year,
it would be advantageous to install a
perpetual inventory system, since our
present set-up, oftentimes due to ma-
terials running out, causes delays in
deliveries. We feel that an inventory
system would prevent much of this
annoyance.

We feel that the over-all ap-
proach, as outlined above, will result
in substantial progress during the com-
ing year.

John Glancy,
Manager, Surgical Appliance Shop

Maintaining cleanliness in an institu-
tion of some 17 buildings with such
varied uses as exist at The Children's
Hospital Medical Center is indeed a
difficult task. During the past year the
housekeeping department has endeav-
ored to get this work done with a force
of approximately 100 people and an
expenditure of nearly $300,000.

The most serious problem facing
our department is the procurement
and retention of qualified personnel.
Our turnover rate exceeded 100 per
cent during the past year, making it
extremely hard to provide good serv-
ice. The primary causes for this rapid
turnover appear to be a low wage
scale, barely above unemployment
compensation in some cases, inade-
quate employee facilities such as
locker rooms and employee lounges,
and the lack of an organized incentive
program in which the employee can
improve his standing. All these prob-
lems are getting active attention and
within budgetary limits a real effort
is being made to improve these con-
ditions.

The varied uses of the 17 build-
ings — a sampling of which includes
patient rooms, operating rooms, public
corridors, doctors' offices, animal
rooms, dormitory rooms, and dental
offices — make cleaning a complex
problem. Emphasis must, of course,
always be placed on the patient and
clinical areas. The importance of
cleanliness in hospitals is obvious. The
role of the cleaning man must be
recognized and every effort made to
dignify his or her job both socially
and financially. Only by doing this
will we maintain the high standards
required.

Frank W. Dickey
Executive Housekeeper

In 1956 the Medical Center expanded
its duplicating room from a simple
electric mimeograph with one opera-
tor into a more up-to-date printing
shop with an offset duplicator. Since
that time the shop has added two per-
sons to its work force, and to its
equipment it has added a folding ma-
chine, punch press, graph duplicator,
light table, paper cutter, collator, photo
copy vacuum exposure frame and elec-
tric stapler.

During the fours years of opera-
tion the volume of work has risen
sharply. The shop now does, in addi-
tion to all of the duplicating, a large
portion of the Medical Center's print-
ing. Work from affiliating institutions
and neighboring hospitals has been ac-
cepted to maintain a uniform work
load. The dollar volume of this out-
side work amounts to $10,000-12,000
per year.

Although the operation of our
own shop has effected some savings,
its most important contribution has
been its on-the-spot service during a
time of great change and growth
throughout the Center. The greatest
need in this area now is a better work-
ing space. The entire operation is
crowded into one small, poorly venti-
lated basement room.

The Hospital post office is lo-
cated near the print shop, employs two
persons, and is under the same super-
vision as the print shop.

Salvatore Caliguri
Supervisor, Print Shop

149

REPORT OF WOMEN'S COMMITTEE

REPORT OF
WOMEN'S COMMITTEE

The Women's Committee of The
Children's Hospital Medical Center has
had a busy year. Following the deci-
sion of the Board of Trustees of The
Children's Hospital to merge the vari-
ous units of The Children's Medical
Center into The Children's Hospital
Medical Center, at our December 1959
meeting we voted to change our name
to the Women's Committee of The
Children's Hospital Medical Center.
We invited the entire Staff Wives
group to join the Women's Commit-
tee as a standing committee and as in-
dividual members. This entailed an
amendment to our by-laws. Before
this new amendment was passed, the
number of Active Members had been
fixed at 125. The chairman of the
Staff Wives Committee, Mrs. Ran-
dolph K. Byers, is a member of our
Executive Committee.

Two new committees were
formed this year, the Volunteer Serv-
ice Committee and the Decorating
Committee. The Volunteer Service
Committee, with Mrs. Weston W.
Adams as chairman, was organized in
April with representatives of the doc-
tors, Nursing and Administrative De-
partments, the director of Volunteer
Service, a member of the Staff Wives
group and chairman of the Women's
Committee as members. Its functions
are to advise on Volunteer Service and
to plan the annual Volunteer Party.
This year's party took place on May
19 at Gardner House. Dr. Alexander
S. Nadas of the Cardiology Division
was the speaker. Volunteer pins were
awarded. About 175 attended.

The new Decorating Committee
consists of three members of the
Women's Committee, one of them on
the Executive Board. Mrs. Kirke A.
Neal is the chairman, assisted by Mrs.
Frederick R. Weed and Mrs. Joseph T.
Ryerson, Jr. This year the Hunnewell
Admitting Entrance was decorated and

additions were made to the Doctors'
Lounge. A new project has been the
hanging of paintings in appropriate
areas of the hospital. These paintings,
loaned by the Art Wagon of the In-
stitute of Contemporary Art, are hang-
ing in the lobby of the Good Samari-
tan building and in the Orthopedic
Out-Patient Waiting Room.

Many special events kept us busy
during the year. On February 9 the
Women's Committee gave a birthday
party to commemorate the 18 th year
of the Surgical Dressings group. On
March 8 the Volunteers and Friends
meeting took place at the Jimmy Fund
Building with Dr. Robert J. Haggerty
as the speaker, assisted by Miss Doro-
thy Pratt. On July 14 the Stagemobile
of the Children's Theatre group pre-
sented the play The Jesters at the
Jimmy Fund Building, financed by the
Women's Committee.

Our Committee contributed in
various ways to the social activities of
the Hospital Staff. It was our pleasure
to provide many special teas. One, re-
quested by Dr. Lendon Snedeker, on
October 15 th, entertained the Child
Study Association of America. An-
other Tea, on April 11, honored Dr.
Charles A. Janeway's guest, Dr. Vernon
Collins of Australia. In September we
gave a Tea on the Prouty Terrace for
the Study Group of the International
Federation of Hospitals. We also co-
operated in giving a luncheon for the
wives of this group at the Massachu-
setts Institute of Technology Faculty
Club and taking them on a tour of
Concord. We cooperated with Mrs.
Kathleen Higgins, Director of Volun-
teer Service, in entertaining the Coun-
cil of Directors of Volunteers of
Greater Boston Hospitals, on Septem-
ber 20th. These Special Teas were in
addition to our regular monthly
Nurses' Teas at Gardner House and
the weekly Coffees for parents and

150

REPORT OF WOMEN'S COMMITTEE

foreign visitors, held in the Confer-
ence Dining Room. In July we as-
sisted at the picnic held at Rivers
Country Day School for all the house
staff and their wives and children and
in September at the third annual pic-
nic held for the hospital employees.

In addition to our activities
within the hospital we attended the
meetings of the American Hospital
Association and the Massachusetts
Hospital Association. In January Mrs.
Byers and I represented the Women's
Committee at the Greater Boston Re-
gional Group of Hospital Auxiliaries,
at Women's Free Hospital. Monday,
March 28, was Auxiliary Day at the
New England Hospital Assembly,
which Mrs. Robert H. Hopkins, Mrs.
David Wilder, Mrs. Weston W.
Adams and I attended. In May the
Massachusetts Hospital Association
had a meeting to which Mrs. David
Wilder, Mrs. Joseph P. Greer and I
v/ent. In August we were represented
in San Francisco at the 62nd annual
meeting of the American Hospital As-
sociation by Mrs. Joseph P. Greer and
Mrs. Arthur H. Nelson.

Our monthly meetings have
heard a variety of speaker who have
given their time to keep us up to date
on hospital activities. In October Mr.
Joseph P. Greer outlined suggestions
for our contributions to the Hospital.
In December Dr. Franc D. Ingraham
gave us a fascinating talk with slides
and this was followed by a tour of the
Neurosurgical Research Laboratory,
with Dr. Edgar A. Bering, Jr., as guide.
Dr. Louis K. Diamond spoke to us on
"Blood Groupings" in January, and
we toured the new Blood Bank, guided
by its director, Dr. A. Richardson
Jones. In February Dr. Adam Sortini
spoke on "Hearing Problems of Chil-
dren and Adults." Our Program Meet-
ing, arranged by the chairmen of our
various committees, was held in March.

In April Dr. Robert E. Gross gave us
a demonstration of his work, assisted
by Dr. David L. Collins and the head
anesthetist, Miss Betty E. Lank. It was
my pleasure to have the May Picnic
Meeting at my house, and Mr. Joseph
P. Greer spoke to us there on present
and future plans of the hospital.

On the financial side, our dona-
tion to the hospital totals $32,908.
Outside community activities, the Daf-
fodil Club, the Cohasset Music Festival
and the Cataumet Hospital Week,
brought in $6,124 of this amount. Our
own committees, the Lunch Shop, the
Gift Shop, the Thrift Shop and the
Yankee Bookstall accounted for
$22,804, a sum to be proud of. With
the addition of dues, donations, Re-
membrance Fund and library contribu-
tions, we have been able to give
$5,581 to the Hospital Building Fund,
$324 to the Social Service Department,
$3,700 to the Education and Recrea-
tion Department, $100 to the Whit-
tington Memorial Fund and $15,000
for requests from Department Heads.

Besides diese specific gifts we
carry on our annual obligations, such
as salaries, magazine subscriptions,
Christmas gifts to Hospital Employees,
Hospital Association dues and travel
expenses as well as donations of
flowers and plants throughout the hos-
pital.

REPORTS OF THE SUB-COMMITTEES

Christmas Window Painting — Chair-
man, Mrs. George H. Sweetnam. Mrs.
Sweetnam and her Committee of ten
painters continue enthusiastically
painting Santas, Rudolphs, etc., all over
the hospital. They get some of their
ideas directly from the children them-
selves.

Gift Shop — Chairman, Mrs. H. Ray-
mond Wilkinson. The Gift Shop had
a wonderful year. A luncheon meeting
was held at the hospital in November

for the Gift Shop Chairmen of the
Massachusetts Hospital Association.
Mrs. Wilkinson was Chairman of the
event, assisted by the Gift Shop Volun-
teers.

Girl Scouts — Chairman, Mrs. George
A. Clapp. The Girl Scouts turn in
scrapbooks, magazines and toys, which
are much enjoyed by the patients.

Holiday Committee — Chairman, Mrs.
Stephen Little. Favors were provided
for nine holidays during the year. The
favors were made by Needham and
Wellesley Girl Scouts and the Boston
and Weston Junior Red Cross.

Hospitality Committee — Chairman,
Mrs. Sidney H. Wirt. At the weekly
Coffees on Wednesday afternoons in
the Conference Dining Room, parents
from twenty-two states and eleven for-
eign countries were entertained. The
Lunch Shop provides the food.

Knitting Committee — Chairman, Mrs.
Francis A. Harding. A grand total of
118 articles were knitted for the chil-
dren by twenty-one faithful knitters,
plus three Church Groups. A new
group from Mattapan, called "Chums
of Children," has been added. Still
more recruits are needed for the com-
ing year.

Library Committee — Chairman, Mrs.
Kenneth W. Warren. Over 3,000
books were circulated from the Pa-
tients' Library on the seventh floor of
Children's Hospital and over 1,500
more books from the library of the
House of the Good Samaritan. A total
of twenty volunteers staff the libraries
and the bookcart. In addition to hos-
pital work, this Committee sent boxes
of used books to the Ranfurly Out-
Island Library in the Bahamas and also
to the Island of Ramea off Newfound-
land. This year 241 new volumes were
added to the fine collection of books,
both foreign and domestic.

151

REPORT OF WOMEN'S COMMITTEE

Membership — Chairman, Mrs. Robert
H. Hopkins. Mrs. Hopkins reported
that we have eighty-one new members
this year, including thirty-five active
members, twenty-seven sustaining and
contributing members and nineteen
associate members. We regret the loss
of four members, one deceased and
three resigned.

Lunch Shop — Chairman, Mrs. Samuel
S. Stevens. The Lunch Shop continues
to give excellent service to everyone
in the hospital. A special feature is
the policy of extra low prices for chil-
dren. The Lunch Shop Volunteers
gave over 7,800 hours of work and the
sum of $8,000 to the hospital.

Nurses' Teas — Co-Chairmen, Mrs.
O. B. B. Rapalyea and Mrs. Richard U.
Wakeman. Eight teas were held for
the nurses in Gardner House. The
Christmas Tea, which included doctors
as well as other hospital groups, was
one of the largest we have ever had.

Photography — Chairman, Mrs. Albert
H. Hittel. This project continues to
given pleasure to parents in many
parts of the world who receive pictures
of their children taken with our Pola-
roid Camera.

Surgical Dressings — Chairman, Mrs.
Joel M. Barnes. This group has given
800 hours in the hospital and more
hours at home. Four Church Groups
have helped, and a remarkable total of
over 162,000 dressings have been
made for the hospital.

Thrift Shop — Chairman, Mrs. David
Wilder. Receipts increased slightly to
$3,834 but so did the expenses; there-
fore the net profit was slightly lower
than last year, $2,187. More donations
are needed and a bundle should be
brought to each meeting.

Staff Wives Committee — Chairman,
Mrs. Randolph K. Byers. This com-

mittee, organized in 1952, operated in-
dependently until January, I960, when
it joined the Women's Committee as
a standing committee and its members
joined individually. Their activities
included a tea at Mrs. John Enders'
house for new house staff in January,
two morning parties at the house of
Mrs. Harry Shwachman in July and a
fall dance in November.

Volunteer Service Committee — Chair-
man, Mrs. Weston W. Adams. This
newest standing committee of the
Women's Committee was organized
last spring to act as a liaison between
the professional services of the staff of
the hospital and its volunteers. It
hopes to be of assistance in solving
problems of placement and in recruit-
ing volunteers. The committee or-
ganized and helped to run the Volun-
teer Party in May.

Yankee Bookstall — Chairman, Mrs.
Alfred Thomas. The proceeds of the
sale of $5,581 were given to the Hos-
pital Building Fund. Massachusetts
Horticultural Hall has proved to be a
convenient place for the sale, and it
will be held there this April 6 through
April 11.

REPORTS FROM OTHER UNITS

Children's Mission to Children — Mrs.
Alexander S. Nadas. A new project of
this unit is consultation service to the
Child Health Unit of Children's Hos-
pital in addition to its regular activi-
ties of foster home placement and the
parent guidance.

House of The Good Samaritan — Miss
Margaret A. Revere. On January 1,
1961, the House of the Good Samari-
tan celebrated its 100th anniversary.
This unit now houses the Respirator
Unit, the Heart Clinic and the Rheu-
matic Fever cases and convalescent
children. The photocardiograph ma-

chine donated by the Women's Com-
mittee this year will be very useful.

Infants' Hospital — Mrs. Charles F.
Hovey. Miss Gladys Beardwood, head
nurse of the Infants' Hospital, and
Mrs. Carolyn Overfors, head nurse of
the Premature Nursery, reported the
hospital has been filled to capacity.
The Women's Committee magazines
are enjoyed in the waiting rooms, and
the Baby Tendas are much appre-
ciated.

These many activities could not
be carried on without the help of all
our members, most especially the hard-
working chairmen of the various com-
mittees and the efficient members of
the Executive Committee. To all I
want to express my heartfelt gratitude
for the support and cooperation they
have given me during my three years
in office. It has been stimulating, in-
teresting to work with them all. My
very special thanks go to Miss Dorothy
Rutherford, who has been a bulwark of
strength. It has been a great privilege
and a wonderful experience to serve
you as Chairman and through the com-
mittee to serve this truly great Chil-
dren's Hospital Medical Center.

Mrs. Charles F. Hovey
Chairman, Women's Committee

152

REPORT OF WOMEN'S COMMITTEE

FINANCE COMMITTEE REPORT

At the Annual Meeting of the Women's Committee on November 15, the Finance
Committee presented the following recommendations for funds to be voted:

Proceeds (Yankee Bookstall) to
Building Fund of the Hospital

Women's Committee Obligations
Recreation Services
Teas and Entertainment
Knitting Committee
Library Committee
Holiday Committee
Flower Fund
Discretionary Fund

Received from Remembrance Fund
(Paid to Hospital Social Service)

600.00
1,500.00
100.00
250.00
100.00
200.00
150.00

>,581.29

2,900.00

324.00

Items for Contribution

Hi-Fidelity Record Player 75.00

Prisma Glasses 100.00

Baby Tendas 50.00

Recreation — Towards Salaries & Play Equipment 5,500.00

Kitchenette & Small Lounge — 19 Peabody Street 1,500.00

Funds for Tickets— Student Nurses ($250) 700.00

House Staff ($450)

Tape Recorder for X-Ray Therapy Area 250.00

Television Sets — Purchasing New & Replacing 3,000.00

Scholarship Fund — Nurses 1,500.00
Conference Dining Room — Cupboards, Sink & Hotplate 1,000.00

Staff Wives Committee— Fall Dance 500.00

Hospital Picnics — House Staff & Employees 500.00

Flower Fund— Additional for 1961 100.00

Discretionary Fund — Additional for 1961 100.00

Hospital Bowling League 125.00

Total

15,000.00
$23,805.29

Mrs. George P. Buell, Chairman

Mrs. Stewart H. Clifford

Mrs. Roger A. Perry

153

REPORT OF WOMEN'S COMMITTEE

ACTIVE MEMBERS

Adams, Mrs. Weston W.
Alden, Mrs. John M.
Allen, Mrs. W. Lloyd
Almy, Mrs. Robert B.
Almy, Mrs. Robert B.
Anthony, Mrs. Carroll G.

Bainbridge, Mrs. Robert P.
Barnes, Mrs. Joel M.
Bartlett, Mrs. Charles W.
Batchelder, Mrs. Charles F.
Bering, Mrs. Edgar A., Jr.
Bigelow, Mrs. Edward L., Jr.
Brewer, Mrs. Cyrus
Brickley, Mrs. Philip E.
Buell, Mrs. George P.
Bursk, Mrs. Edward C.
Burwell, Mrs. C Sidney
Byers, Mrs. Randolph K.
Berenberg, Mrs. William

Carney, Miss Dorothy M.
Clapp, Mrs. Eugene H., II
Clifford, Mrs. Stewart H.
Coburn, Miss Louise
Crandell, Mrs. John C, Jr.
Crigler, Mrs. John F., Jr.
Crockett, Mrs. Charles B.

Dale, Mrs. John
Damon, Mrs. Lawrence B.
Diamond, Mrs. Louis K.
Drorbaugh, Mrs. James E.
Drury, Mrs. Samuel S.
Dyer, Mrs. Edwin C.

Elliott, Mrs. Byron K.
Emerson, Mrs. Edward L.
Emery, Mrs. Forrest S.
Erickson, Mrs. Joseph A.

Ferguson, Mrs. Charles F.
Flood, Mrs. Richard T.
Floyd, Mrs. Richard C.
Foster, Mrs. Reginald, Jr.
French, Mrs. Stanley G.

Gerrity, Mrs. Frank
Gettings, Mrs. James H.
Gibby, Mrs. Harry
Gillette, Mrs. Howard F.
Good, Mrs. Arthur J.
Greer, Mrs. Joseph P.

Haffenreffer, Mrs. Theodore
Haggerty, Mrs. Robert J.
Hansel, Mrs. Lawrence H.
Harding, Mrs. Donald F.
Harding, Mrs. Francis A.
Harwood, Mrs. Bartlett, Jr.

Hebbard, Mrs. William E.
Hendren, Mrs. W. Hardy.
Hopkins, Mrs. Robert H.
Hornblower, Mrs. Henry, II.
Hovey, Mrs. Charles F.,
Hunnewell, Mrs. Walter, Jr.
Hurlbut, Mrs. Cornelius, Jr.

Johnson, Mrs. John H.
Johnson, Mrs. Laurence H. H.

Karp, Mrs. Meier
Kennard, Mrs. Robert M. P.
Kieran, Mrs. John
Kiley, Mrs. John G, Jr.
Knight, Mrs. Richard C.
Knowles, Mrs. John H.
Kroto, Mrs. Hans,

Lanman, Mrs. Thomas H..
Latham, Mrs. Earle O.
Leland, Miss Elizabeth C.
Levin, Mrs. Benjamin
Liebman, Mrs. Sumner
Little, Mrs. Stephen
Lombroso, Mrs. Cesare T.
Lowe, Mrs. Samuel L., Jr.
Lyman, Mrs. Ronald T., Jr.

Mercer, Mrs. Douglas, Jr.
Mitchell, Mrs. Emlyn V.
Munro, Mrs. Edward S..
Murphy, Mrs. Edward L.
Mueller, Mrs. Harry L.

Nadas, Mrs. Alexander S.
Nelson, Mrs. Arthur H.
Nordbeck, Mrs. Theodore E.

Ober, Mrs. Frederick C.

Paige, Mrs. Francis A.
Paine, Mrs. Richmond S.
Painter, Mrs. Whitfield
Palmer, Mrs. Henry W.
Parker, Mrs. James F.
Parsons, Mrs. Ernst,
Perry, Mrs. Roger A.
Petremont, Mrs. Dorothy P.
Pettit, Mrs. Charles H.
Pfeffer, Mrs. William
Pollock, Mrs. Robert J.
Pratt, Mrs. Albert
Potter, Mrs. Gary

Rapalyea, Mrs. Oldfield B. B.
Revere, Miss Margaret A.
Riley, Mrs. Russell F.
Robb, Mrs. Walter E., Jr.
Rogers, Miss Dorothy
Russell, Mrs. Otis T.

Ryerson, Mrs. Joseph T., Jr.

Sawyer, Mrs. Henry B.
Scott, Mrs. J. Gordon
Sears, Mrs. Richard D.
Smith, Mrs. Everett W.
Smith, Mrs. Robert M.
Steele, Mrs. Keith C.
Stevens, Mrs. Samuel S.
Stewart, Mrs. Frank H.
Summers, Mrs. Merle G.
Sutton, Mrs. Gardner
Sweetnam, Mrs. George H.
Sylvester, Mrs. Albert I.

Tappan, Mrs. Robert A.
Thayer, Mrs. Sherman R.
Thomas, Mrs. Alfred
Thompson, Mrs. George E.

Wakeman, Mrs. Richard V.
Walker, Mrs. Rufus F.
Wallace, Mrs. Jacob
Walworth, Mrs. Gardner C.
Warren, Mrs. Kenneth W.
Weed, Mrs. Frederick R.
Welch, Mrs. Hillard W.
Wellington, Mrs. Stephen B.
Wetherald, Miss Dorothy P..
Whittemore, Mrs. Robert M.
Wilder, Mrs. David
Wilkinson, Mrs. H. Raymond
Williams, Mrs. Barrett
Williams, Mrs. Willis E.
Wilson, Mrs. Samuel T.
Winter, Mrs. William D, Jr.
Wirt, Mrs. Sidney H.
Wolcott, Mrs. Samuel H.